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DOI: 10.1055/s-2007-966643
© Georg Thieme Verlag KG Stuttgart · New York
Spontaneous regression of rectal polyps following abdominal colectomy and ileorectal anastomosis for familial adenomatous polyposis, without sulindac treatment: Report of four cases
Publication History
submitted 9 January 2007
accepted after revision 12 February 2007
Publication Date:
05 July 2007 (online)
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The only curative treatment for familial adenomatous polyposis (FAP) is prophylactic surgery and the two most popular options are total colectomy with ileorectal anastomosis and restorative proctocolectomy with ileal pouch-anal anastomosis. Today, ileal pouch-anal anastomosis has gained wider acceptance as a safer procedure, but ileorectal anastomosis still remains an option, especially for young patients with a moderate phenotype of the disease and limited polyps in the rectum. Partial or complete regression of rectal polyps after total colectomy with ileorectal anastomosis and treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) such as sulindac is reported in up to 80 % of patients. However, in some cases such regression can be spontaneous and long-lasting following total colectomy and ileorectal anastomosis, without further treatment with NSAIDs. We present the cases of four patients with FAP treated by colectomy and ileorectal anastomosis, who had immediate, complete spontaneous regression of multiple polyps in the rectal stump, with no further need for sulindac treatment.
References
- 1 Bulow C, Vasen H, Jarvinen H. et al . Ileorectal anastomosis is appropriate for a subset of patients with familial adenomatous polyposis. Gastroenterology. 2000; 119 1454-1460
- 2 Winde G, Gumbinger H G, Osswald H. et al . The NSAID sulindac reverses rectal adenomas in colectomized patients with familial adenomatous polyposis: clinical results of a dose-finding study on rectal sulindac administration. Int J Colorect Dis. 1993; 8 13-17
- 3 Farmer K C, Phillips R K. Colectomy with ileorectal anastomosis lowers rectal mucosal cell proliferation in familial adenomatous polyposis. Dis Colon Rectum. 1993; 36 167-171
- 4 Feinberg S M, Jagelman D G, Sarre R G. et al . Spontaneous resolution of rectal polyps in patients with familial polyposis following abdominal colectomy and ileorectal anastomosis. Dis Colon Rectum. 1988; 31 169-175
- 5 Vasen H F, van der Luijt R B, Slors J F. et al . Molecular genetic tests as a guide to surgical management of familial adenomatous polyposis. Lancet. 1996; 348 433-435
- 6 Tiainen J, Matikainen M, Hiltunen K M. Ileal J-pouch-anal anastomosis, sexual dysfunction, and fertility. Scand J Gastroenterol. 1999; 34 185-188
- 7 Fasth S, Filipsson S, Hellberg R. et al . Sexual dysfunction following proctocolectomy. Ann Chir Gynaecol. 1978; 67 8-12
- 8 O’Sullivan M J, McCarthy T V, Doyle C T. Familial adenomatous polyposis: from bedside to benchside. Am J Clin Pathol. 1998; 109 521-526
- 9 Tonelli F, Valanzano R, Messerini L, Ficardi F. Long-term treatment with sulindac in familial adenomatous polyposis: is there an actual efficacy in prevention of rectal cancer?. J Sur Oncol. 2000; 74 15-20
- 10 Shepherd J A. Familial polyposis of the colon with special reference to regression of rectal polyposis after subtotal colectomy. Br J Surg. 1971; 58 85-91
- 11 Arvanitis M L, Jagelman D G, Fazio V W. et al . Mortality in patients with familial adenomatous polyposis. Dis Colon Rectum. 1990; 33 639-642
G. M. Filippakis, MD, PhD
Hippokration General Hospital
Propaedeutic Surgical Department A
115 Vass. Sofias Ave.
Abelokoipoi, P.C.: 11526
Athens
Greece
Fax: +30-210-7483770
Email: gfilipp@hotmail.com