Panproctocolectomy and Ileostomy PI

For prevention of cancer development in patients with ulcerative proctocolitis, complete removal of all potential malignant colorectal mucosa has to be done. Before the advent of the surgical options of our days, panproctocolectomy with construction of a conventional ileostomy was the standard procedure for cancer prophylaxis in patients with longstanding ulcerative colitis. Such an operation eliminates further risks of colorectal cancer and no surveillance should be needed. Although cancer in the ileostomy in these patients has been demonstrated to occur many years after surgery, this is probably a different state of affairs [31]. Bowel metaplasia may occur where gut contents come into regular contact with the squamous epithelium of the skin, which is an important step in the development of these rare tumours, as is also true in some cases of adenocarci-noma of the oesophagus. Ileostomy cancer develops at the mucocutaneous junction of the ileostomy, and chronic irritation caused by trauma and/or chemical agents from stoma appliances or adhesives may be factors in its unclear etiology.

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