Non-restorative surgery in the treatment of Crohn's disease of the large bowel

Abstract

SUMMARY This study gives detailed information on the two principal groups of patients undergoing excisional surgery with a permanent artificial stoma for Crohn's disease of the large bowel. During the years 1952-71, 64 patients were treated by total proctocolectomy aQdileostomy and 26 patients by excision of the distal large bowel and colostomy.In the group of patients undergoing proctocolectomy, there were two postoperative and six late deaths. Of the 56 patients alive at the end of the follow-up period (average length of follow-up 8.1 years), four had shown evidence of recurrent disease. In each case this occurred following a staged proctocolectomy and at, or immediately proximal to, the ileostomy: the shortest interval between surgery and recurrence was just under 10 years.Among the patients treated by excision of the distal large bowel, there were two unrelated late deaths: with an average duration of follow up of 7.3 years, recurrent disease occurred in only one of the 24 patients alive at the concluding date for this study.The essential diagnostic features of large bowel Crohn's disease have been delineated in a number of studies from this hospital (Lockhart-Mummery and Morson, 1960, 1964;Morson, and Dawson, 1972) and, using these criteria, the surgery undertaken in 84 cases was described (Jones, Lennard-Jones, and Lockhart-Mummery, 1966). The intention in the present paper is to present the results of surgery in the two main groups of patients undergoing excisional operations with the establishment of a permanent artificial stoma. These operations are total proctocolectomy and ileostomy (carried out for diffuse or extensive disease) and excision of the distal large bowel with a terminal colostomy (undertaken for disease apparently confined to the sigmoid colon and rectum). The study includes patients treated by these operations mentioned in the earlier paper and is an elaboration of the results already published in brief by Lockhart-Mummery (1972).The criteria which have been applied for the selection of patients for this enquiry are as follows.(1) Patients have been included if (a) laparotomy only, (b) appendicectomy, (c) (a)

Epidemiological aspects of Crohn's disease in Clydesdale 1961-1970.

“…Large series dealing with management from referral centres in Leeds (De Dombal, Burton, and Goligher, 1971), Birmingham (Burman, Thompson, Cooke, and Williams, 1971), and London (Ritchie and Lockhart-Mummery, 1973) have not shown such a difference, although the epidemiological studies of Kyle (1971) from a geographically separate part of Britain, and of Farlander and Baerlocher (1971) from Basle, have produced sex ratios close to those of the present study. While the peak incidence was observed in the third and fourth decades for females and males respectively, 31 % of Clydesdale patients were over the age of 50 at the time of presentation.…”

Characterization and Clinical Behavior of Crohn's Disease Initially Presenting Predominantly as Colitis

“…[20][21][22] Total proctocolectomy with end ileostomy is an alternative to IPAA, but there is also a risk of recurrence with this procedure that varies between 8 and 14.8 percent. 23,24 Our data suggest that the presence of granulomatous disease and segmental colonic involvement at presentation reflect a more virulent clinical course in patients with Crohn's colitis. IPAA may be offered as an option in select cases of Crohn's colitis, without perianal and small-bowel involvement.…”

The granuloma in Crohn's disease.

“…Lockhart-Mummery, 1973;Steinberg, et al, 1974). Fourteen patients had disease confined at primary surgery to the small bowel, 43 confined to the large bowel, and 22 had ileocolitis.…”