Our Summary

This research paper is about a condition called proctitis which happens rarely after a type of bowel surgery called sigmoidectomy. The researchers looked at the medical records of patients who had this surgery in Västmanland County, Sweden, between 2008 and 2020. They focused on patients who had a procedure called colorectal anastomosis, which is where the surgeon reconnects the remaining parts of the bowel after removing a section. They didn’t include people who didn’t have this reconnecting procedure or people who had inflammatory bowel disease.

Out of 546 patients who had the surgery, 233 were included in the study. Of these, 26 (or 11.2%) developed proctitis. The most common symptoms were needing to go to the toilet urgently, going to the toilet more often, and pain in the rectum and anus. Most of these patients (76.9%) had a treatment called endoscopic balloon dilation, where a balloon is inserted into the bowel and then inflated to stretch it. Half of these patients only needed this treatment once, but the average number of times this treatment was needed was three.

The researchers found that patients who had surgery because of cancer, who had emergency surgery, or who smoked were more likely to get proctitis. They suggest that because the symptoms can be quite mild, especially in patients who have a diverting stoma (a temporary or permanent opening in the abdomen to divert waste away from the colon), it would be a good idea to routinely check the rectum with an endoscope (a long, thin, flexible tube with a light and camera at the end) after sigmoidectomy.

FAQs

  1. What is the incidence of proctitis distal to colorectal anastomosis among patients who underwent sigmoidectomy?
  2. What factors were associated with an increased risk of proctitis in patients who had a sigmoidectomy?
  3. What is the recommended follow-up procedure after a sigmoidectomy to monitor for proctitis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sigmoidectomy is to be aware of the potential risk of developing proctitis distal to the colorectal anastomosis. Patients should be vigilant for symptoms such as urgency, increased stool frequency, and anorectal pain, and inform their healthcare provider if they experience any of these symptoms. Additionally, patients who undergo surgery due to malignancy, have a history of smoking, or undergo emergency surgery may be at increased risk for developing proctitis, so they should discuss these factors with their healthcare provider. Regular follow-up appointments and routine endoscopic rectal examinations may be necessary to monitor for proctitis after sigmoidectomy.

Suitable For

Patients who have undergone sigmoidectomy with colorectal anastomosis are typically recommended sigmoidectomy if they develop proctitis distal to the anastomosis. In this study, patients who underwent surgery due to malignancy and emergency surgery were found to be at an elevated risk of developing proctitis. Additionally, patients with a history of smoking were also associated with an increased risk of proctitis. It is important for healthcare providers to be aware of these potential risk factors in order to provide appropriate monitoring and treatment for patients who have undergone sigmoidectomy.

Timeline

Before sigmoidectomy:

  • Patient experiences symptoms that lead to the decision to undergo sigmoidectomy, such as abdominal pain, changes in bowel habits, or rectal bleeding.
  • Preoperative consultations and tests are conducted to assess the patient’s overall health and determine the best course of treatment.
  • The patient undergoes sigmoidectomy surgery, which involves removing a portion of the sigmoid colon and creating a colorectal anastomosis.

After sigmoidectomy:

  • Postoperative recovery period, where the patient stays in the hospital for monitoring and pain management.
  • Follow-up appointments to monitor the patient’s progress and address any complications that may arise.
  • Development of proctitis distal to colorectal anastomosis in some patients, characterized by symptoms such as urgency, increased stool frequency, and anorectal pain.
  • Treatment for proctitis may include endoscopic balloon dilation, with some patients requiring multiple procedures.
  • Identification of risk factors for proctitis, such as surgery due to malignancy, emergency surgery, and a history of smoking.
  • Recommendations for routine endoscopic rectal examination during follow-up after sigmoidectomy to detect proctitis early and provide appropriate treatment.

What to Ask Your Doctor

  1. What is proctitis distal to colorectal anastomosis and how common is it following sigmoidectomy?
  2. What are the symptoms of proctitis and how is it diagnosed?
  3. What are the potential risk factors associated with developing proctitis after sigmoidectomy?
  4. What treatment options are available for proctitis distal to colorectal anastomosis?
  5. How many endoscopic balloon dilations may be needed for treatment and what is the success rate?
  6. How often should follow-up appointments be scheduled after sigmoidectomy to monitor for proctitis?
  7. Are there any lifestyle changes or habits that can help reduce the risk of developing proctitis after surgery?
  8. Is there a difference in the risk of proctitis based on the reason for surgery (e.g. malignancy vs. other reasons)?
  9. What are the potential complications of proctitis if left untreated?
  10. Are there any specific warning signs or symptoms that should prompt immediate medical attention after sigmoidectomy?

Reference

Authors: Khan A, Nikberg M, Smedh K, Chabok A. Journal: Ann Coloproctol. 2024 Oct;40(5):498-505. doi: 10.3393/ac.2023.00675.0096. Epub 2024 Oct 22. PMID: 39434556