Subtotal colectomy and cecosigmoid anastomosis for colonic systemic sclerosis - Report of a case and review of the literature

PURPOSE: We report a case of subtotal colonic involvement of systemic sclerosis, successfully managed by subtotal colectomy and cecosigmoid anastomosis, and review the literature on surgical management. METHODS: A patient had profound slow transit constipation and severe colonic involvement on nuclear transit study. Surgery was conservative, with preservation of distal sigmoid colon and the ileocecal valve. A literature search regarding management of colonic systemic sclerosis was conducted. RESULTS: The surgery was uncomplicated and near normal bowel function was restored. The literature indicates that colonic involvement is common in systemic sclerosis and that surgery is sometimes required for severe disease or the development of complications. CONCLUSIONS: If surgery is required for colonic involvement in systemic sclerosis, it should be directed at the segmental distribution of the disease, preserving the colon if possible and considering the possibility of concurrent small-bowel involvement. Nuclear colonic transit study is helpful in guiding the extent of surgery.