Twenty-six cases of Crohn's disease of the colon treated by total colectomy and ileorectal anastomosis have been examined. Recurrent disease at the anastomosis occurred in 50% of patients, three-quarters of these within 18 months and the latest six years after operation. Patients with disease apparent only in the colon at the primary operation developed ileal recurrence at the anastomosis as commonly as those with both ileum and colon involved initially. Recurrence in the small intestine away from the anastomosis was uncommon. The response of recurrent disease to medical treatment was encouraging and further surgical intervention has been avoided in the majority of cases.
Complicated anal fistulae developed in 20% of patients up to seven years after ileo-rectal anastomosis. They materially affected the management of the individual patient but most responded to conventional surgical treatment after a prolonged healing period.
Ileo-rectal anastomosis for Crohn's disease of the colon has had a lower operative morbidity than the same operation performed for ulcerative colitis, but the long-term prognosis has been worse because of the development of recurrent disease and serious anal lesions.
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