The effect of split ileostomy on perianal Crohn's disease

Abstract

The effect of 32 split ileostomies on 29 patients with severe symptomatic perianal Crohn's disease is reported. The perianal disease improved or healed after 23 (72 per cent) split ileostomies, although it relapsed in 2 patients while diverted and in 6 after closure of split ileostomy. Seven of 12 rectovaginal fistulas healed initially but only remained healed in those patients without rectal involvement with disease. At the time of review 6 patients have normal bowel continuity, 8 have had proctocolectomies and 15 are still defunctioned. Split ileostomy should be considered as an initial step in the management of intractable perianal disease.

Chirurgische Therapie hoher anorectaler und rectovaginaler Fisteln mittels transanaler endorectaler Verschiebelappenplastik

“…Wäh-rend einige Autoren einen günstigen Effekt bei gleichzeitiger Stomaanlage postulieren [9,11], geben andere sogar eine Zunahme der perinealen Läsionen während der Stomaphase an [24]. Im Allgemeinen wird davon ausgegangen, daû durch die gleichzeitige Stuhlableitung eine Nahtinsuffizienz nicht verhindert werden kann [3,12].…”

Enterovaginal Fistula in Crohn’s Disease

“…One possible reason is that the fistulas became less trouble some after diversion. This is certainly the case in some patients [6], Patients may then refuse further treatment, accepting the stoma out of fear of a flare-up of the dis ease.…”

“…The present review is biased because two of these reports focus on special aspects: Harper et al [6] on the value of split en terostomy without mentioning whether any patients were treated otherwise, and Bandy et al [3] on the merits of local repair, mentioning patients treated in other ways but not giving the results in these cases.…”

Case Series: Does a Combination of Anti-TNF Antibodies and Transient Ileal Fecal Stream Diversion in Severe Crohnʼs Colitis With Perianal Fistula Prevent Definitive Stoma?

“…Anti-TNF α antibodies have been shown to be eff ective in healing both luminal lesions ( 2 ) and perineal fi stulas ( 3 ). In addition, the fecal diversion using a transient ileal stoma has also been shown eff ective to induce colonic and perineal healing ( 4,5 ). Several studies, performed before the era of anti-TNF α treatments, showed that despite an improvement of Crohn ' s colitis by fecal stream diversion, a permanent stoma is usually required ( 6,7 ).…”