Mr. B______, a 50 year old patient from Saudi Arabia came to me with bleeding while passing stools (also read this interesting case ) since childhood. He was often treated for piles in his country but there was no relief. Ultimately being frustrated with his disease, he came to India. He was skinny and pale. I examined his anal canal but did not see any plies. There appeared some mass in rectum. I posted him for colonoscopy. Almost whole of his colon from rectum to cecum was involved with multiple small grape like growths called polyps. I biopsied few of them and they came benign. The diagnosis of Multiple colonic polyposis was established.
There was no one else is his family who had similar complaints. I discussed with him about the disease and the treatment. I proposed to him complete removal of his colon including rectum (Total proctocolectomy) as these polyps can become cancerous. His immediate concern was will he live a normal life after the surgery? I assured him that life will be not normal but much better. He will get rid of his bleeding and anemia. He will however have more frequency of stools and they will be more liquid then normal. I discussed with him about temporary ileostomy and assured him that he will eventually pass stools from his anal canal. The surgery was smooth. It took me about 6 hours to operate him.I removed his whole of colon including his rectum as it was diseased using modern ultrasonic energy device so that there was very limited blood loss.
I removed his whole of colon including his rectum as it was diseased using modern ultrasonic energy device so that there was very limited blood loss.
The terminal part of small intestine was modified to make a reservoir (J-pouch) for his stools
and was now connected to his anal canal. The joints were made using the modern staplers.
In such major surgeries there is always a risk of leakage from this new joint. Hence, in order to protect this joint (anastomosis), I had to divert his stools. This will allow the joint to heal nicely without getting contaminated and infected as if this happens then there is a risk to his life. Hence, I performed a diverting ileostomy for some time till he recovers. This means he will pass stools thro a small hole on his tummy into a bag. He recovered well. After few weeks I carried out radiological test and colonoscopy to ensure that the new reservoir and the joint had healed properly. I took his for his second surgery in which I had to simply close his ileostomy. He started passing stools from below about 5 – 7 times daily. He had good sensation & control over his stools and and there was no urgency. He happily returned to his home in Saudi Arabia.