Temporary fecal diversion in the management of colorectal and perianal Crohn's disease.

Rudolf Mennigen,Britta Heptner,Emile Rijcken,Norbert Senninger

doi:10.1155/2015/286315

Rudolf Mennigen, Britta Heptner + Show 2 more

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https://doi.org/10.1155/2015/286315

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Abstract

Aim. To evaluate the results of temporary fecal diversion in colorectal and perianal Crohn's disease. Method. We retrospectively identified 29 consecutive patients (14 females, 15 males; median age: 30.0 years, range: 18–76) undergoing temporary fecal diversion for colorectal (n = 14), ileal (n = 4), and/or perianal Crohn's disease (n = 22). Follow-up was in median 33.0 (3–103) months. Response to fecal diversion, rate of stoma reversal, and relapse rate after stoma reversal were recorded. Results. The response to temporary fecal diversion was complete remission in 4/29 (13.8%), partial remission in 12/29 (41.4%), no change in 7/29 (24.1%), and progress in 6/29 (20.7%). Stoma reversal was performed in 19 out of 25 patients (76%) available for follow-up. Of these, the majority (15/19, 78.9%) needed further surgical therapies for a relapse of the same pathology previously leading to temporary fecal diversion, including colorectal resections (10/19, 52.6%) and creation of a definitive stoma (7/19, 36.8%). At the end of follow-up, only 4/25 patients (16%) had a stable course without the need for further definitive surgery. Conclusion. Temporary fecal diversion can induce remission in otherwise refractory colorectal or perianal Crohn's disease, but the chance of enduring remission after stoma reversal is low.

Highlights

IntroductionRefractory colorectal or perianal Crohn’s disease still mandates surgical interventions
Despite modern medical therapies, refractory colorectal or perianal Crohn’s disease still mandates surgical interventions
Most patients (21/29, 72.4%) had previous operations or endoscopic interventions for the same indication that led to the actual temporary stoma creation, meaning that temporary fecal diversion was not the first line treatment in the majority of patients

Summary

Introduction

Refractory colorectal or perianal Crohn’s disease still mandates surgical interventions. For colorectal Crohn’s disease, this usually means colectomy with ileorectal anastomosis or terminal ileostomy, or, in cases of severe rectal inflammation or complex perianal manifestations, proctocolectomy with terminal ileostomy. These operations have relevant and irreversible consequences that may not be acceptable especially for young patients. Several authors have already reported astonishing rates of clinical remissions of colorectal Crohn’s disease following stoma creation in the 60s and 70s [1,2,3,4] In these early reports, the authors primarily employed stoma creation to control the inflammatory process and to ameliorate the general condition and the nutritional status of their patients before proceeding to definite surgical resections as mentioned above (like a “bridge to surgery”). In the 80s and 90s, most authors still did not recommend reversal of these stomas as they saw little chance of enduring remission once the intestinal continuity was restored [5, 6], while only few authors proposed reversal of these stomas in case of clinical remission [7]

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