This topic revolves around the decision of whether to undergo a full proctocolectomy after having an emergency ileostomy. A 29-year-old individual, who had a permanent ileostomy due to a perforated colonic mass in 2016, is considering this surgery. They still have 15 cm of disconnected colon and rectum, which produces blood-stained mucus daily. Doctors have diagnosed this as diversion proctitis. The person is unsure about having elective surgery to remove the remaining colon and rectum and is concerned about the potential increased risk of colorectal cancer if it remains.

Here are some insights and advice shared by others:

1. Risk of cancer in the rectal stump: Many have been advised by their colorectal surgeons that leaving an unused rectum or colon in place can increase the long-term risk of cancer. Regular monitoring or complete removal is often recommended.

2. Alternative options: If Crohn’s disease is ruled out, one option could be reversing to a J-pouch. Otherwise, a completion proctectomy, which is the full removal, is commonly suggested. It's wise to seek second or even third opinions from surgeons before making a decision.

3. Managing symptoms while deciding: Fatty-acid enemas and cortisone suppositories can help reduce bleeding and cramps from diversion proctitis, though insurance coverage for these treatments may vary.

4. Quality-of-life improvements from removal:
- Eliminates daily bleeding, mucus, and occasional leakage due to weakened rectal muscles.
- Provides peace of mind regarding cancer surveillance.
- Although post-operative recovery can be challenging, many find it worthwhile after about three months.

5. Concerns about fertility and sexual function: One person chose to delay surgery until after having children, as a proctectomy can sometimes affect pelvic nerves, impacting sexual function.

6. Considerations for those with other health issues: Individuals with significant cardiovascular disease, diabetes, or who are older may face higher surgical risks. It's important to weigh the urgency of symptoms against these risks.

7. Finding experienced care: A recommendation was made for the Colon and Rectal Care office on the north side of Indianapolis, known for good outcomes.