The Ileum Following Colectomy

The surgical removal of all or the greater part of the large intestine is done to relieve symptoms resulting from extensive disease of the colon. The ileum may be anastomosed with the sigmoid, the rectum, or the anus, or may be brought out through the skin to form a permanent ileostomy. A number of writers (1, 2, 3, 6, 7, 10, 12, 13) have observed that, as time passes, the intestinal contents discharged from the ileum under these conditions gradually become less fluid. This has been interpreted as evidence of increasing ability of the ileum to absorb water and thus make the stool of more normal consistency. In several cases, gross dilatation of the ileum was found at a subsequent operation (1, 2, 12). In a recent report Dennis and Karlson (5) state that enlargement of the ileum does not occur proximal to an ileostomy which is functioning properly. Mueller and Fischer (10) demonstrated increase in diameter and the development of large mucosal folds in the ileum of dogs following transplantation after excision of a portion of the colon, although the microscopic appearance of the ileum was not changed. The purpose of this paper is to present the results of roentgen studies of the ileum at various intervals after one of the above-mentioned surgical procedures. Material Eighteen patients were examined, of whom 10 had an ileostomy, 4 ileosigmoidostomy, 2 ileoproctostomy, 1 ileo-anal anastomosis, and 1 sigmoidocecostomy. Most of the patients had small-intestine studies following the ingestion of barium preparations; a few had barium enema examinations, and some had both. Non-flocculating barium preparations were used for those patients who were brought in during the past year for this particular investigation. It seemed that the non-flocculating preparations were more satisfactory than barium in saline solution. The barium enema gave satisfactory results as far as showing the size of the ileum and the condition of the stoma was concerned. The enema demonstrated the anastomosis better, in fact, than did ingested barium. Results of the Examinations On the basis of the examinations the patients fell into four groups, as follows. (I) those with no demonstrable abnormality of the ileum; (II) those with dilatation associated with inflammatory disease of the ileum; (III) those with dilatation associated with a constriction or stenosis at or distal to the anastomosis; (IV) 2 cases of dilatation of the ileum without obvious cause. Group I includes 9 patients: 6 with ileostomy and 1 with ileo-anal anastomosis for ulcerative colitis; 2 with ileoproctostomy, 1 for congenital polyposis and 1 for Hirschsprung's disease. The examinations ranged in time from three to fifteen years subsequent to the operation. None of these patients had demonstrable dilatation of the ileum (Figs. 1 and 2).