Division of General Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Veterans Affairs Health Services Research and Development, West Los Angeles Veteran Affairs Administration, Los Angeles, California.
Dis Colon Rectum. 2018 Feb;61(2):214-220. doi: 10.1097/DCR.0000000000000985.
Severe acute refractory colitis has traditionally been an indication for emergent colectomy in IBD, yet under these circumstances patients are at elevated risk for complications because of their heightened inflammatory state, nutritional deficiencies, and immunocompromised state.
We hypothesized that rescue diverting loop ileostomy may be a viable alternative to emergent colectomy, providing the opportunity for colonic healing and patient optimization before more definitive surgery.
This was a retrospective case series.
The study was conducted at a single academic center.
Patients with severe acute medically refractory IBD-related colitis were included.
Rescue diverting loop ileostomy was the intervening procedure.
The primary outcome was avoidance of urgent/emergent colectomy. The secondary outcome was efficacy, defined by 3 clinical aims: 1) reduced steroid dependence or opportunity for bridge to medical rescue, 2) improved nutritional status, and 3) ability to undergo an elective laparoscopic definitive procedure or ileostomy reversal with colon salvage.
Among 33 patients, 14 had Crohn's disease and 19 had ulcerative colitis. Three patients required urgent/emergent colectomy, 2 with ulcerative colitis and 1 with Crohn's disease. Across both disease cohorts, >80% of patients achieved each clinical aim for efficacy: 88% reduced their steroid dependence or were able to bridge to medical rescue, 87% improved their nutritional status, and 82% underwent an elective laparoscopic definitive procedure or ileostomy reversal. A total of 4 patients (11.7%) experienced a postoperative complication following diversion, including 3 surgical site infections and 1 episode of acute kidney injury.
The study was limited by being a single-center, retrospective series.
Rescue diverting loop ileostomy in the setting of severe, refractory IBD-colitis is a safe and effective alternative to emergent colectomy. This procedure has acceptably low complication rates and affords patients time for medical and nutritional optimization before definitive surgical intervention. See Video Abstract at http://links.lww.com/DCR/A520.
严重急性难治性结肠炎在炎症性肠病（IBD）中一直是紧急结肠切除术的指征，但在这种情况下，由于患者处于高度炎症状态、营养缺乏和免疫抑制状态，他们发生并发症的风险增加。
我们假设，挽救性转流性回肠造口术可能是紧急结肠切除术的一种可行替代方法，为更确定性手术前提供结肠愈合和患者优化的机会。
这是一项回顾性病例系列研究。
研究在一家学术中心进行。
纳入患有严重急性药物难治性 IBD 相关结肠炎的患者。
挽救性转流性回肠造口术是干预措施。
主要结局是避免紧急/紧急结肠切除术。次要结局是疗效，定义为 3 个临床目标：1）减少类固醇依赖或桥接医学救援的机会，2）改善营养状况，3）进行择期腹腔镜确定性手术或带有结肠保留的回肠造口术逆转的能力。
在 33 名患者中，14 名患有克罗恩病，19 名患有溃疡性结肠炎。3 名患者需要紧急/紧急结肠切除术，2 名溃疡性结肠炎患者和 1 名克罗恩病患者。在两个疾病队列中，超过 80%的患者达到了疗效的每个临床目标：88%的患者减少了类固醇依赖或能够桥接医学救援，87%的患者改善了营养状况，82%的患者进行了择期腹腔镜确定性手术或回肠造口术逆转。总共有 4 名患者（11.7%）在转流术后发生术后并发症，包括 3 例手术部位感染和 1 例急性肾损伤。
该研究受到单中心、回顾性系列研究的限制。
在严重、难治性 IBD-结肠炎的情况下，挽救性转流性回肠造口术是紧急结肠切除术的安全有效替代方法。该手术并发症发生率低，为患者提供了在确定性手术干预前进行医学和营养优化的机会。在 http://links.lww.com/DCR/A520 上观看视频摘要。
