Role of Fecal Diversion in Complex Crohn's Disease

Abstract

Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in progressive tissue damage, which can result in strictures, fistulae, and abscesses formation. The triggering mechanism is thought to be in the fecal stream, and diversion of this fecal stream is sometimes required to control disease when all other avenues of medical and surgical management have been exhausted. Fecal diversion can be temporary or permanent with the indications being defunctioning a high-risk anastomosis, as a result of a surgical complication, for disease control, or due to severe colonic, rectal, or perianal disease. The incidence of ostomy formation in CD has increased epidemiologically over time. The primary indication for ostomy formation is severe perianal fistulizing disease. However, while 64% of patients have an early clinical response after diversion for refractory perianal CD, restoration of bowel continuity is attempted in only 35% of patients, and is successful in only 17%. The current review discusses the indications for ostomy creation in complex CD, strategies for procedure selection, and patient outcomes.

Healing of rectal advancement flap for anal fistula in patients with and without Crohn’s disease: a retrospective cohort analysis

“…A proximal bowel diversion is previously reported to be associated with lower recurrence rates after anal stula surgery. However, studies do not agree on whether and when, depending on the severity of the underlying disease, a positive effect can be achieved 36,37 . In our work, CD patients were more likely to have a protective stoma, but this did not affect the healing rate.…”

Clinical Factors Associated With Response to Fecal Diversion in Crohn’s Disease

“…It is unclear however why we did not find any adverse effect of perianal disease on patient outcomes after fecal diversion as suggested by other investigators. [10][11][12][13][14] Perhaps, the severity of colorectal disease treated in our tertiary referral center "balanced out" the negative effect of perianal disease. Since there are few clinical factors associated with CR, we are currently evaluating the predictive value of subclinical makers such as serum I2 4 in this patient cohort.…”

Healing of rectal advancement flaps for anal fistulas in patients with and without Crohn’s disease: a retrospective cohort analysis

“…Proximal bowel diversion was previously reported to be associated with lower recurrence rates after anal fistula surgery. However, studies do not agree on whether and when a positive effect can be achieved depending on the severity of the underlying disease [ 37 , 38 ]. In our work, CD patients were more likely to have a protective stoma, but this did not affect the healing rate.…”