Recurrence of Crohn's disease in end ileostomies

Abstract

: It appears well established that the recurrence rates following operations for Crohn's disease of ileum and colon are higher after anastomotic operations than after an end ileostomy. To obtain further information regarding the rate of recurrence following end ileostomy we reviewed the charts of 182 patients: 117 with involvement of the ileum as well as the colon, and 65 with Crohn's colitis only, who were operated upon at the Mt. Sinai Hospital during 1952-1984. They were followed until death or the first ileostomy revision or the last contact. Of the ileocolitis group, 50 patients (43%), and of the colitis group, nine patients (14%) required an ileostomy revision. Of the 50 with ileocolitis, 34 (29%) and four of the colitis group (6.2%) had revisions done primarily for recurrent Crohn's disease at or near the stoma. The estimated overall cumulative probability of recurrence was 50% twenty years following ileostomy, and was significantly higher in the ileocolitis group than in the colitis group (64% vs. 15%; p < 0.001), with mean follow-up durations of 6.5 and 7.5 years, respectively. The probability of ileostomy revision for any reason was also significantly higher for patients with ileocolitis (74% vs. 34%; p < 0.001). We conclude that the site of initial Crohn's disease plays a role in the recurrence of disease in an end ileostomy, with a better outlook for patients with colonic involvement alone.

Systematic review with meta‐analysis: recurrence of Crohn's disease after total colectomy with permanent ileostomy

“…Of 2017 unique studies identified using our search strategy, 17 studies met our inclusion criteria . In addition, we identified one abstracts from conference proceedings and hence, included a total of 18 studies for quantitative synthesis.…”

“…Six studies were performed in North America and 12 in Europe . Of note, three studies were performed at a single centre, of which two reported clinical recurrence over a non‐overlapping period, and one reported surgical recurrence; hence, all three studies contributed to the analyses.…”

“…Ten studies including 1092 patients evaluated the risk for reoperation due to recurrence . On meta‐analysis, the rate of surgical recurrence was 16.0% (95% CI, 11.1–22.7; 183/1092 patients), with considerable heterogeneity ( I 2 = 84%) (Figure ).…”

“…Seven studies reported the rate of stoma‐related complications requiring surgery after TC‐PI in 701 patients . On meta‐analysis, the rate of re‐operation was 15.6% (95% CI, 8.5–27.0; 108/701 patients), with considerable heterogeneity ( I 2 = 78%) (Figure S2).…”

Postoperative recurrence of Crohn's disease: Pathophysiology and prevention

“…In a group of 182 patients with an end ileostomy for CD 64% of those with ileocolitis as initial presentation had recurrence in the neoterminal ileum after 20 years, versus 15% of those with colitis (p < 0.001) (57).…”