Abstract
A-33-year old male who had been diagnosed with ulcerative colitis 2 years previously was admitted to our hospital with lower abdominal pain and bloody stool. Despite the administration of various types of conservative therapies over a 3-month period, the symptoms did not improve. Furthermore, colonofiberscopy and a barium-enema showed severe stricture at the rectum and sigmoid colon. As a result, he underwent hand-assisted laparoscopic total colectomy and ileal J-pouch proctostomy. The histological findings revealed an irregular thickness of the proper muscle layer, thus resulting in severe stricture of the rectum and sigmoid colon. The inflammation of ulcerative colitis tends to mainly occur in the mucosa and submucosa, therefore the occurrence of severe stricture is rare. In Japan, previous cases of ulcerative colitis with severe stricture have only been reported in 10 other cases. The indications of the surgical treatment of ulcerative colitis can be separated into two types, namely absolute and palliative. In the absolute indication cases, almost all operations are carried out as emergency operations, for patients with such symptoms as major hemorrhaging, perforation, peritonitis, and toxic megacolon. In the palliative indication cases, operations are carried out as elective operations for persistent disease, and these operations are selected for both the curability of disease and to maintain the patient's quality of life. The case reported herein is thus considered to be a good candidate for an elective, hand-assisted laparoscopic total colectomy and ileal J-pouch proctostomy.
