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Mr. Zhang (pseudonym), 38, is a university teacher from Shanxi.
10 years ago, Mr. Zhang began to be plagued by diarrhea, diarrhea 5 to 10 times a day, mainly mucus stool, sometimes mucus blood stool, has seriously affected life.
So he went to the hospital to check and found that this was not ordinary diarrhea and simple enteritis, he was diagnosed with ulcerative colitis, which is a type of inflammatory bowel disease.
The local hospital has given mesalazine, azathioprine, hormones and other control symptoms.
It is not enough to change the liver, but also to change the intestines?
After 2 years, Mr. Zhang's skin began to appear yellow, and a check found that it was primary sclerosing cholangitis. For liver disease, liver protection and ursodeoxycholic acid drugs are also treated. However, Mr. Zhang's liver disease has not been well controlled, and severe liver cirrhosis has occurred. So in 217, he underwent a "liver transplant" (liver transplant) and continued anti-immune rejection therapy after the operation.
After the liver transplantation, Mr. Zhang's diarrhea improved in the short term, but later, the diarrhea was aggravated again, and various drugs were adjusted successively for treatment, and the effect was not good.
Mr. Zhang, who was tortured to the point of near collapse, went to Zhou Wei, chief physician of the Department of General Surgery at Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine, to seek treatment.
After full evaluation, the doctor considered that Mr. Zhang's colonic intestinal lesions had developed into lead-tube-like changes and required surgical treatment in the form of total colorectal resection + ileal storage bag anastomosis (IPAA), which removed the whole colon and rectum of the lesion, and made the small intestine into a storage bag instead of the large intestine to store stool ("easy intestine").
CT manifestations of the abdomen
The condition is very complicated
Difficult surgery won him a new life
Because Mr. Zhang had previously undergone open abdominal liver transplantation and the hypertrophy and adhesion of the mesangial hyperplasia around the peritoneal colon, the doctor formulated a phase 3 IPAA for him according to the actual situation.
In April 2020, laparoscopic assisted total colonectomy + terminal ileostomy was performed;
In February 2021, laparoscopic residual rectal resection + ileal reservoir canal anastomosis + ileal protective stoma was performed;
In July 2021, ileostomy was performed.
The number of surgeries is large, involving multiple quadrants of the abdominal cavity, the texture of the intestinal tube is brittle, the mesangial hypertrophy is obvious... The condition was very complicated and the surgical process was arduous, but through the efforts of the multidisciplinary team of the Inflammatory Bowel Disease Center of Zhejiang University Shaw Hospital, Mr. Zhang successfully survived the perioperative period.
Especially when the stoma was finally evaluated, because of the nature of Mr. Zhang's work, the distal storage bag was absent for a long time, and the colonoscopy found that the anastomosis of the original open storage bag had been completely narrowed and occluded, but the doctor used double-mirror combined storage bag stenosis dilation to save the storage bag for Mr. Zhang.
It took one year and three months for the patient to successfully complete the entire surgical process.
Endoscopic dilation under dual mirror combination
"Light of Hope"
Before being discharged from the hospital, Mr. Zhang wrote a letter of thanks, in which he said that he thanked the medical staff of the Inflammatory Bowel Disease Center of Run Shaw Hospital for saving him from his serious illness and winning a new life.
Click on the larger image to see the full thank-you note
What patients need IPAA surgery?
IPAA surgery is a difficult and complex intestinal surgery, which is currently considered to be mainly for ulcerative colitis and familial polyposis, and some patients with Crohn's disease can also consider this surgery.
What is ulcerative colitis (UC)?
UC is a type of inflammatory bowel disease (IBD), a chronic inflammatory lesion that occurs in the mucosa and submucosa of the colon, and the peak age of incidence is usually 15 to 35 years old and 50 to 55 years old.
The combination of environment, diet, immunity, genes, intestinal flora, and many other factors triggers the body's inflammatory process, which cannot be shut down normally, ultimately leading to the occurrence of disease.
Among them, 6 to 8% of patients with UC may have primary sclerosing cholangitis (PSC), and 60% to 80% of patients with PSC may have UC.
What are the symptoms of ulcerative colitis?
UC often presents with diarrhea, bloody stools, abdominal cramps, and tight defecation, and patients with UC and PSC are characterized by rectal immunity, right half colon domination, retroferrous ileitis, and symptoms such as jaundice, skin itching, and fatigue.
Ulcerative colitis
When do I need to consider surgery?
Common drug treatments for ulcerative colitis include mesalazine, hormones, cyclosporine, biologics, etc., and the appropriate drugs are selected according to the condition.
However, the following conditions require surgical treatment:
1
Acute severe UC with ineffective drug therapy;
2
Chronic recurrent UC with poor efficacy in internal medicine treatment;
3
UC at an advanced age with poor efficacy of the drug;
4
Patients with a long course of illness complicated by colonic stenosis;
5
UC cancerous.
What are the surgical modalities for IPAA?
The main principle of surgical treatment is the removal of all diseased colons and rectum, and total colorectal resection + canal anastomosis (IPAA) surgery in the ileal reservoir bag is the gold standard.
Depending on the condition, there are three-stage surgery, two-stage surgery, or first-stage surgery.
Previously, the surgical team of the Inflammatory Bowel Disease Center of Run Run Shaw Hospital for the first time in China adopted the innovative achievement of President Chua Xiujun of Run Shaw Hospital", "Stent Method Intestinal Diversion", to carry out modified phase I IPAA surgery, which avoided ileal protective stoma surgery through the clever use of biodegradable stents, on the one hand, reduced the number of IPAA operations (all treatments can be completed in one operation), and at the same time, intestinal bowel bowel movements could be restored early after surgery, reducing the risk of bag openness narrowing and bag leakage.
IPAA surgery
The "Stent Method" improves the first phase of IPAA
In which patients can "stenting" be used?
Ulcerative colitis, familial polyposis, low-level rectal cancer, etc. can be considered to use "stent method of intestinal rotation", which on the one hand can avoid the possibility of intestinal ostomy (intestinal decontamination), while reducing the risk of surgery and reducing medical costs.
Source: Run Run Shaw Hospital
Author: Ge Xiaolong, Department of General Surgery
Original works, reprinted please indicate the source and source
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