Risks of Total Colectomy

A total colectomy is typically performed to cure ulcerative colitis, familial adenomatous polyposis or Crohn’s disease. The surgeon will either remove the colon and leave the rectum--a sub total colectomy--or remove both colon and rectum, which is called a total abdominal colectomy. The small intestine is then joined to the rectum or anus--depending on the procedure--with the use of an ileal pouch, which is is a chamber made from a portion of the lowest part of the small intestine. This pouch then acts as a reservoir with the goal of returning to regular bowel habits.

Procedural Risk

• As with any surgery, there are risks during and after the total colectomy. These can include heart attack and (rarely) death. The patient can also hemorrhage or develop blood clots in the leg and/or lung veins. After surgery, patients are at risk for anastomotic leaks or breakdowns where the bowel is connected together. The wound stitching could also leak liquid from the digestive duct (pouch fistula). Additional risks include a narrowing for the new join, causing difficulty in passing bowel movements and infections at the site of needle punctures.

Dehydration Risks

• The colon is an organ that is used mainly to absorb water and salt from liquid stool. An adult colon processes about one to two liters of liquid stool daily. By the time the liquid stool gets to the rectum, only about 120 ml of liquid is left as the colon has absorbed much of the water and salt. If the colon is removed, the person is at higher risk for dehydration and hyponatremia as he is not retaining as much water and salt. The lack of colon makes people have to defecate more and have more liquid stools.

Pouch Risks

• Along with anastomotic leaks and pouch fistulas, total colectomy patients are also at risk for pelvic sepsis and abscesses within the pouch. According to the Journal of Pediatric Gastroenterology and Nutrition, these occur in five percent to 20 percent of patients. Pouch failure will ultimately occur in 30 percent of patients, with three percent mortality. Total colectomy patients are also at risk for distal obstructions/blockages in the bowels by thickened stools.