Skip to main content
PMC home page
Gut logoLink to Gut
. 1993 Oct;34(10):1384–1388. doi: 10.1136/gut.34.10.1384

Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn's disease.

S P Grobler 1, K B Hosie 1, E Affie 1, H Thompson 1, M R Keighley 1
PMCID: PMC1374546  PMID: 8244106

Abstract

Twenty of 81 patients treated by restorative proctocolectomy for presumed ulcerative colitis had some features of Crohn's disease: 10 were classified as definite Crohn's disease and 10 as indeterminate colitis. These pathological features were first apparent during synchronous colectomy and pouch construction in 10 of 11 cases. In the remainder, histological features of possible Crohn's disease were first identified during rectal excision (n = 6), preliminary subtotal colectomy (n = 2), and after pouch excision (= 2). Complications were marginally more common in patients with features of possible Crohn's disease: pelvic sepsis 30% (Crohn's disease 30%, indeterminate colitis 30%) v 20%, fistulas 45% (Crohn's disease 30%, indeterminate colitis 60%) v 16%; ileal stenosis 40% (Crohn's disease 40%, indeterminate colitis 40%) v 21%, pouchitis 50% (Crohn's disease 50%, indeterminate colitis 50%) v 26%, and small bowel obstruction 25% (Crohn's disease 30%, indeterminate colitis 30%) v 13%. Pouch excision or a persistent proximal stoma has been necessary in six patients with possible Crohn's disease (30%) (Crohn's disease 3 cases 30%, indeterminate colitis 3 cases 30%) compared with nine (15%) of the remainder. Median hospital stay, however, was the same and stool frequency in those with a functioning pouch were comparable. These results show that there is a higher complication rate if there are features of Crohn's disease but that the medium term functional results are acceptable if the pouch can be retained.

Full text

PDF
1386

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Deutsch A. A., McLeod R. S., Cullen J., Cohen Z. Results of the pelvic-pouch procedure in patients with Crohn's disease. Dis Colon Rectum. 1991 Jun;34(6):475–477. doi: 10.1007/BF02049932. [DOI] [PubMed] [Google Scholar]
  2. Dozois R. R., Goldberg S. M., Rothenberger D. A., Utsunomiya J., Nicholls R. J., Cohen Z., Hultén L. A., Moskowitz R. L., Williams N. S. Restorative proctocolectomy with ileal reservoir. Int J Colorectal Dis. 1986 Jan;1(1):2–19. doi: 10.1007/BF01648830. [DOI] [PubMed] [Google Scholar]
  3. Dozois R. R., Kelly K. A., Beart R. W., Jr, Beahrs O. H. Improved results with continent ileostomy. Ann Surg. 1980 Sep;192(3):319–324. doi: 10.1097/00000658-198009000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dozois R. R., Kelly K. A., Welling D. R., Gordon H., Beart R. W., Jr, Wolff B. G., Pemberton J. H., Ilstrup D. M. Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. Ann Surg. 1989 Sep;210(3):268–273. doi: 10.1097/00000658-198909000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Grobler S. P., Hosie K. B., Keighley M. R. Randomized trial of loop ileostomy in restorative proctocolectomy. Br J Surg. 1992 Sep;79(9):903–906. doi: 10.1002/bjs.1800790916. [DOI] [PubMed] [Google Scholar]
  6. Halvorsen J. F., Heimann P., Hoel R., Nygaard K. The continent reservoir ileostomy: review of a collective series of thirty-six patients from three surgical departments. Surgery. 1978 Mar;83(3):252–258. [PubMed] [Google Scholar]
  7. Hamilton S. R. The differential diagnosis of idiopathic inflammatory disease by colorectal biopsy. Int J Colorectal Dis. 1987 Jun;2(2):113–117. doi: 10.1007/BF01647703. [DOI] [PubMed] [Google Scholar]
  8. Hyman N. H., Fazio V. W., Tuckson W. B., Lavery I. C. Consequences of ileal pouch-anal anastomosis for Crohn's colitis. Dis Colon Rectum. 1991 Aug;34(8):653–657. doi: 10.1007/BF02050345. [DOI] [PubMed] [Google Scholar]
  9. Jones J. H., Lennard-Jones J. E., Morson B. C., Chapman M., Sackin M. J., Sneath P. H., Spicer C. C., Card W. I. Numerical taxonomy and discriminant analysis applied to non-specific colitis. Q J Med. 1973 Oct;42(168):715–732. [PubMed] [Google Scholar]
  10. Kmiot W. A., Keighley M. R. Totally stapled abdominal restorative proctocolectomy. Br J Surg. 1989 Sep;76(9):961–964. doi: 10.1002/bjs.1800760931. [DOI] [PubMed] [Google Scholar]
  11. Koltun W. A., Schoetz D. J., Jr, Roberts P. L., Murray J. J., Coller J. A., Veidenheimer M. C. Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis. Dis Colon Rectum. 1991 Oct;34(10):857–860. doi: 10.1007/BF02049696. [DOI] [PubMed] [Google Scholar]
  12. Lee K. S., Medline A., Shockey S. Indeterminate colitis in the spectrum of inflammatory bowel disease. Arch Pathol Lab Med. 1979 Apr;103(4):173–176. [PubMed] [Google Scholar]
  13. Lennard-Jones J. E. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl. 1989;170:2–19. doi: 10.3109/00365528909091339. [DOI] [PubMed] [Google Scholar]
  14. Levin K. E., Pemberton J. H., Phillips S. F., Zinsmeister A. R., Pezim M. E. Role of oxygen free radicals in the etiology of pouchitis. Dis Colon Rectum. 1992 May;35(5):452–456. doi: 10.1007/BF02049401. [DOI] [PubMed] [Google Scholar]
  15. Nicholls J., Pescatori M., Motson R. W., Pezim M. E. Restorative proctocolectomy with a three-loop ileal reservoir for ulcerative colitis and familial adenomatous polyposis. Clinical results in 66 patients followed for up to 6 years. Ann Surg. 1984 Apr;199(4):383–388. doi: 10.1097/00000658-198404000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Nicholls R. J. Restorative proctocolectomy with various types of reservoir. World J Surg. 1987 Dec;11(6):751–762. doi: 10.1007/BF01656598. [DOI] [PubMed] [Google Scholar]
  17. Pezim M. E., Pemberton J. H., Beart R. W., Jr, Wolff B. G., Dozois R. R., Nivatvongs S., Devine R., Ilstrup D. M. Outcome of "indeterminant" colitis following ileal pouch-anal anastomosis. Dis Colon Rectum. 1989 Aug;32(8):653–658. doi: 10.1007/BF02555768. [DOI] [PubMed] [Google Scholar]
  18. Price A. B. Overlap in the spectrum of non-specific inflammatory bowel disease--'colitis indeterminate'. J Clin Pathol. 1978 Jun;31(6):567–577. doi: 10.1136/jcp.31.6.567. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Rauh S. M., Schoetz D. J., Jr, Roberts P. L., Murray J. J., Coller J. A., Veidenheimer M. C. Pouchitis--is it a wastebasket diagnosis? Dis Colon Rectum. 1991 Aug;34(8):685–689. doi: 10.1007/BF02050351. [DOI] [PubMed] [Google Scholar]
  20. Scammell B., Ambrose N. S., Alexander-Williams J., Allan R. N., Keighley M. R. Recurrent small bowel Crohn's disease is more frequent after subtotal colectomy and ileorectal anastomosis than proctocolectomy. Dis Colon Rectum. 1985 Nov;28(11):770–771. doi: 10.1007/BF02555471. [DOI] [PubMed] [Google Scholar]
  21. Shepherd N. A. Pathological mimics of chronic inflammatory bowel disease. J Clin Pathol. 1991 Sep;44(9):726–733. doi: 10.1136/jcp.44.9.726. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Tanaka M., Riddell R. H. The pathological diagnosis and differential diagnosis of Crohn's disease. Hepatogastroenterology. 1990 Feb;37(1):18–31. [PubMed] [Google Scholar]
  23. Warren B. F., Shepherd N. A. The role of pathology in pelvic ileal reservoir surgery. Int J Colorectal Dis. 1992 Jun;7(2):68–75. doi: 10.1007/BF00341289. [DOI] [PubMed] [Google Scholar]
  24. Wells A. D., McMillan I., Price A. B., Ritchie J. K., Nicholls R. J. Natural history of indeterminate colitis. Br J Surg. 1991 Feb;78(2):179–181. doi: 10.1002/bjs.1800780214. [DOI] [PubMed] [Google Scholar]
  25. Whitehead R. Colitis: problems in definition and diagnosis. Virchows Arch A Pathol Anat Histopathol. 1990;417(3):187–190. doi: 10.1007/BF01600132. [DOI] [PubMed] [Google Scholar]
  26. Williams N. S. Restorative proctocolectomy is the first choice elective surgical treatment for ulcerative colitis. Br J Surg. 1989 Nov;76(11):1109–1110. doi: 10.1002/bjs.1800761103. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES