Perianal Crohn's disease does not inevitably lead to panproctocolectomy. Cautious surgery for fistula when rectal inflammation is quiescent is worthwhile. Loss of bowel continuity is more likely when colitis coexists with perianal disease. Panproctocolectomy is often indicated because of the combination of colitis and perianal disease rather than for perianal disease alone.

Rates of protein synthesis in vivo in normal and pathological tissues of the gastrointestinal tract, were measured using the 'flooding dose' technique with the stable isotope L-[1-'C] leucine. The rate of protein synthesis in normal colonic mucosa was 9.4 (1.2)% (mean (SEM)) per day but was significantly raised in benign and malignant colorectal tumour tissue, and in colonic mucosa from patients with inflammatory bowel disease (p<0.001). Furthermore, the rate of protein synthesis was significantly greater in benign colorectal tumour tissue, 36.7 (2 5)% per day, than that in either malignant tumour tissue, 21.7 (1.9)% per day, or in inflammatory bowel disease mucosa, 24.7 (2.5)% per day (means (SEM) p<0001). Liver protein synthesis rates were also measured in separate groups of patients with benign disease of the gastrointestinal tract, in patients with colorectal carcinoma, and in patients with inflammatory bowel disease. The fractional rate of liver protein synthesis was 20O7 (1.9)% per day in patients with benign disease and 23.1 (1.6)% per day in patients with colorectal cancer. In patients with inflammatory bowel disease, however, liver protein synthesis was significantly increased to 35 4 (2.3)% per day (means (SEM) p<0.01).

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We report 62 operations for acute colonic inflammatory bowel disease in which the rectal stump was closed. Operative findings were of severe colitis in 46, toxic megacolon in 8 and faecal peritonitis in 8 patients. Histology showed ulcerative colitis in 48, Crohn's disease in 9 and indeterminate colitis in 5 patients. Clinical evidence of stump leakage occurred in only one of 53 patients with a long rectal stump in contrast to 3 of 9 patients who had a short rectal stump. Leaving a very short stump also led to difficulty at subsequent proctectomy in 3 patients and at restorative proctocolectomy in 1 patient. This suggests that careful closure of the rectum above the peritoneal reflection can be a safe means of dealing with the rectal stump after total colectomy and ileostomy for acute colitis.