Jeane,
Gee, this sounds rough, and you really must feel like you are circling the drain right now. But still, if you are anything like me, you will appreciate Dr. Remzi's candor, and not sugar coating the possible outcomes. Knowing what may lie ahead may not be pleasant, but at least you can process it, then make some decisions....move forward fully informed.
Regarding the issue of ischemia, I think what he meant was that even though you did not have the cardinal signs of separation of the anastomosis, you could still have had tension on the suture line and resulting ischemia. Like anything else, it is seldom an "all or nothing" scenario, and occur in varying degrees. A blood clot in a feeder artery would be a sign of ischemia, along with your chronic symptoms. Of course, UC in the retained rectal cuff could be the sole cause too, and that is why they are scratching their heads. They don't want to subject you to more surgery if it would not likely result in a better function. But, you are being evaluated and advised by the best and most experienced, so take comfort in that. Still, it must be quite difficult to have all these multiple issues going on simultaneously!
I recommend you take a "spa day" where you pamper yourself indulgently, try to relax, then ponder all this in a few days. Hopefully, then you will be able to have a good handle on all of this. You seem like a strong person...
Jan