{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:39:02Z","timestamp":1787510342605,"version":"build-2736575974"},"reference-count":65,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: There are multiple decision nodes, during and after subtotal colectomy for ulcerative colitis (UC), regarding the management of the rectal stump. Intra-operatively, the surgeon must decide on the closure technique and positioning of the retained stump, while post-operatively, clinicians often face the challenge of managing diversion proctitis, as well as determining an appropriate endoscopic surveillance strategy, given the increased risk of cancer. This narrative review aims to summarise the evidence relating to these key decision points in rectal stump management. Methods: A narrative review of the literature was performed. Relevant studies were identified through a search of Ovid Medline and Embase. Inclusion criteria were adult population and diagnosis of UC. Cohort studies, review articles, and guidelines were eligible for inclusion. The references were grouped according to the subject of interest and reported accordingly. Results: Intra-peritoneal closure has been shown to have higher pelvic sepsis rates (5\u201325%), whereas subcutaneous placement results in higher rates of wound infections (up to 15%). A mucous fistula has been shown to have the lowest overall complication rate. Microscopic findings compatible with diversion proctitis develop in most patients, with incidence ranging from 71.4% to 100%. However, only a minority of these patients (30\u201340%) develop symptoms. Suggested treatments for diversion proctitis include topical mesalamine, corticosteroids, or short-chain fatty acids. The overall risk of rectal stump neoplasia in patients with UC after subtotal colectomy is as low as 0.7%, with prior colorectal neoplasia being a major risk factor. No universal standardised guidance exists regarding endoscopic surveillance in this patient population. Conclusions: This narrative review has appraised the latest evidence on three crucial stages of rectal stump management in UC. There is still uncertainty about the optimal surgical management of the stump, with different complication profiles. Medical management of diversion proctitis remains a major unmet need, and there are no randomised trials addressing this issue. There are no universally accepted guidelines on endoscopic surveillance of the rectal stump.<\/jats:p>","DOI":"10.3390\/jcm15031114","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T17:38:34Z","timestamp":1769794714000},"page":"1114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Rectal Stump During and After Subtotal Colectomy for Ulcerative Colitis: A Narrative Review of Surgical Strategies, Medical Management Options, and Cancer Surveillance Recommendations"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9165-5613","authenticated-orcid":false,"given":"Orestis","family":"Argyriou","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, St Mark\u2019s the National Bowel Hospital and Academic Institute, London NW10 7NS, UK"},{"name":"Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itai","family":"Ghersin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Mark\u2019s the National Bowel Hospital and Academic Institute, London NW10 7NS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7534-5511","authenticated-orcid":false,"given":"George","family":"Stravodimos","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Worley","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK"},{"name":"Department of Colorectal Surgery, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil","family":"Tozer","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, St Mark\u2019s the National Bowel Hospital and Academic Institute, London NW10 7NS, UK"},{"name":"Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ailsa","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Mark\u2019s the National Bowel Hospital and Academic Institute, London NW10 7NS, UK"},{"name":"Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3885-5752","authenticated-orcid":false,"given":"Kapil","family":"Sahnan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, St Mark\u2019s the National Bowel Hospital and Academic Institute, London NW10 7NS, UK"},{"name":"Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1093\/ecco-jcc\/jjab029","article-title":"The Burden of Inflammatory Bowel Disease in Europe in 2020","volume":"15","author":"Zhao","year":"2021","journal-title":"J. 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