RESTORATIVE PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS FOR SEVERE ULCERATIVE COLITIS IN RURAL NEPAL

For most patients with ulcerative colitis (UC) requiring surgery, restorative proctocolectomy (RP) may be the operation of choice. By using an ileal pouch-anal anastomosis, it offers a curative operation with no need for a permanent ileostomy. We present a 16 year-old boy from a remote village with chronic UC which failed to respond satisfactorily to maximal medical therapy. We opted for elective surgery because he was unlikely to comply with long-term medical therapy and surveillance, nor to survive if he came to emergency surgery in our setting. RP was performed and he recovered well. His bowel habit was better than the 5 or 6 motions per day that is typical following this procedure. Where the expertise is available, the operation can be performed and any complications managed, using only the basic facilities available in most district hospitals. We present this case as an example of the “one-hit medicine” approach that is often required in our context. We suggest that RP may occasionally be indicated for UC in rural Nepal, where the alternatives carry relatively greater disadvantages. Key Words: Restorative proctocolectomy, ileal pouch-anal anastomosis, ulcerative colitis, appropriate technology