Anti-peristaltic ileocolonproctoplasty: a salvage procedure in extensive resective colorectal surgery.

BACKGROUND: In a few patients undergoing extensive colorectal resections, a short intermediate colon segment could be saved and interposed between the ileum and the anorectum, although technical problems usually lead to its loss. CASES PRESENTATION: Two cases of anti-peristaltic ileocolonproctoplasty after demolitive surgery of both proximal and distal colon (necrosis of the colonic stump after debulking of ovarian cancer and Crohn's disease) are reported. Because the length of the colonic stump was insufficient to allow for a regular clockwise rotation of the colon and an orthotopic, iso-peristaltic colorectal anastomosis, the remnant colon was rotated in an anti-clockwise fashion and an anti-peristaltic anastomosis was performed, similar to a technique we have recently proposed (anti-peristaltic cecorectal anastomosis) for slow-transit constipation. Owing to the different pathological and surgical findings, two technical variants were adopted, involving the preservation of the middle colic artery and the left colic artery, respectively. RESULTS: Post-operative course was uneventful, and the patients shortly recovered normal bowel habits (a mean of 4 and 3 motions over 24 h, respectively). CONCLUSIONS: In selected patients, the anti-peristaltic interposition of a saved intermediate colon segment between the ileum and the rectal remnant is an advisable technical solution to preserve some re-absorption and reservoir function and to reduce the risk of diarrhoea, incontinence and urgency.