Total Colectomy, Ileo-Rectal Anastomosis and Rectal Polypectomy in a Patient with Multiple Colonic Polyps – A Case Report

Abstract

Total colectomy with ileorectal anastomosis has previously been the standard operation in familial adenomatous polyposis patients. This is coupled by clearing the distal rectal part with snaring or fulguration. Doing this, avoids an ileostomy in a young patient and the risks associated with nerve injury during pelvic dissection. Avoiding a permanent ileostomy is the biggest challenge that surgeons face when dealing with young patients. Familial adenomatous polyposis is rare in sub-Saharan Africa with little information on how these patients are managed and followed-up according to local standards. A 17-year-old female presented to the surgical unit with a long-standing history of blood in stool for a period of 10 years which was associated with chronic anaemia. The patient was also followed by the gastroenterologists where several endoscopies and colonoscopies were done during this period. The report is aiming to share total colectomy with ileorectal anastomosis as an alternative to pelvic dissection and a permanent ileostomy in Familial adenomatous polyposis. This is should be followed by a good surveillance system to quickly identify any transformation to malignancy as early as possible. The patient was followed for bloody stools and chronic anaemia by the Gastro-enterology unit for a long period until patients family was ready for her to have surgery. Her family was initially not willing for her to have surgery as they considered her too young. She was finally seen by our Surgical Unit where open total colonic resection and ileorectal anastomosis was performed. The patient was discharged and was reviewed as an out-patient at the surgical clinic in good physical and mental health. She was opening bowels and passing flatus with normally. Conclusion: Total-colectomy with end-to-end ileo-rectal anastomosis is a safe procedure in familial adenomatous polyposis in young patients coupled with an appropriate post-operative surveillance.