Skip to main content
NCBI home page
Gut logoLink to Gut
. 1984 Jun;25(6):665–672. doi: 10.1136/gut.25.6.665

Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery.

P Rutgeerts, K Geboes, G Vantrappen, R Kerremans, J L Coenegrachts, G Coremans
PMCID: PMC1432363  PMID: 6735250

Abstract

An endoscopical and histological study was carried out in 114 patients, treated by 'curative' resection of the terminal ileum and part of the colon for Crohn's disease, in order to study the natural history of recurrent Crohn's disease. The recurrence rate of Crohn's disease in patients examined within one year of the operation was 72%. This figure did not differ significantly from that in patients examined one to three years or three to 10 years after surgery (79% and 77% respectively). Recurrence was located in the neoterminal ileum and at the anastomosis in 88% of the patients. Early endoscopic signs of recurrence were small aphthous ulcers in the neoterminal ileum. Ileal biopsies at this stage showed an important inflammatory cell infiltrate of the lamina propria with numerous eosinophils and fusion and blunting of the villi. More advanced lesions observed in patients examined one to three years after surgery, consisted of larger, often serpiginous ulcerations and nodular thickening of folds. In patients examined three to 10 years after the operation, the anastomosis was frequently stenosed and rigid, with large ulcers extending from the stenosis into the colon. Mucosal granulomas may be found in normal appearing mucosa as well as in the obviously inflamed mucosa surrounding the ulcers. These studies suggest that recurrence of Crohn's disease almost always develops in the first year after the operation. Significant endoscopic lesions may be present without clinical symptoms, particularly in the earlier stages of the disease.

Full text

PDF
665

Images in this article

669Fig. 2
on p.669
670Fig. 3
on p.670
671Fig. 4
on p.671

Selected References

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

  1. Atwell J. D., Duthie H. L., Goligher J. C. The outcome of Crohn's disease. Br J Surg. 1965 Dec;52(12):966–972. doi: 10.1002/bjs.1800521214. [DOI] [PubMed] [Google Scholar]
  2. Barber K. W., Waugh J. M., Beahrs O. H., Sauer W. G. Indications for and the Results of the Surgical Treatment of Regional Enteritis. Ann Surg. 1962 Sep;156(3):472–480. doi: 10.1097/00000658-196209000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bechi P., Romagnoli P., Cortesini C. Ileal mucosal morphology after total colectomy in man. Histopathology. 1981 Nov;5(6):667–678. doi: 10.1111/j.1365-2559.1981.tb01833.x. [DOI] [PubMed] [Google Scholar]
  4. Chambers T. J., Morson B. C. The granuloma in Crohn's disease. Gut. 1979 Apr;20(4):269–274. doi: 10.1136/gut.20.4.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. De Dombal F. T., Burton I., Goligher J. C. Recurrence of Crohn's disease after primary excisional surgery. Gut. 1971 Jul;12(7):519–527. doi: 10.1136/gut.12.7.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Farmer R. G., Hawk W. A., Turnbull R. B., Jr Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology. 1975 Apr;68(4 Pt 1):627–635. [PubMed] [Google Scholar]
  7. Geboes K., Vantrappen G. The value of colonoscopy in the diagnosis of Crohn's disease. Gastrointest Endosc. 1975 Aug;22(1):18–23. doi: 10.1016/s0016-5107(75)73675-1. [DOI] [PubMed] [Google Scholar]
  8. Glass R. E., Baker W. N. Role of the granuloma in recurrent Crohn's disease. Gut. 1976 Jan;17(1):75–77. doi: 10.1136/gut.17.1.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Goligher J. C. Inflammatory disease of the bowel: results of resection for Crohn's disease. Dis Colon Rectum. 1976 Oct;19(7):584–587. doi: 10.1007/BF02590972. [DOI] [PubMed] [Google Scholar]
  10. Greenstein A. J., Sachar D. B., Pasternack B. S., Janowitz H. D. Reoperation and recurrence in Crohn's colitis and ileocolitis Crude and cumulative rates. N Engl J Med. 1975 Oct 2;293(14):685–690. doi: 10.1056/NEJM197510022931403. [DOI] [PubMed] [Google Scholar]
  11. KIEFER E. D., MARSHALL S. F., BROLSMA M. P. The management of chronic regional ileitis. Gastroenterology. 1950 Jan;14(1):118–130. [PubMed] [Google Scholar]
  12. Koch T. R., Cave D. R., Ford H., Kirsner J. B. Crohn's ileitis and ileocolitis: a study of the anatomical distribution of recurrence. Dig Dis Sci. 1981 Jun;26(6):528–531. doi: 10.1007/BF01308102. [DOI] [PubMed] [Google Scholar]
  13. Lee E. C., Papaioannou N. Recurrences following surgery for Crohn's disease. Clin Gastroenterol. 1980 May;9(2):419–438. [PubMed] [Google Scholar]
  14. Lennard-Jones J. E., Stalder G. A. Prognosis after resection of chronic regional ileitis. Gut. 1967 Aug;8(4):332–336. doi: 10.1136/gut.8.4.332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Nugent F. W., Veidenheimer M. C., Meissner W. A., Haggitt R. C. Prognosis after colonic resection for Crohn's disease of the colon. Gastroenterology. 1973 Sep;65(3):398–402. [PubMed] [Google Scholar]
  16. Pennington L., Hamilton S. R., Bayless T. M., Cameron J. L. Surgical management of Crohn's disease. Influence of disease at margin of resection. Ann Surg. 1980 Sep;192(3):311–318. doi: 10.1097/00000658-198009000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Rutgeerts P., Geboes K., Ponette E., Coremans G., Vantrappen G. Acute infective colitis caused by endemic pathogens in western Europe: endoscopic features. Endoscopy. 1982 Nov;14(6):212–219. doi: 10.1055/s-2007-1021624. [DOI] [PubMed] [Google Scholar]
  18. Truelove S. C., Pena A. S. Course and prognosis of Crohn's disease. Gut. 1976 Mar;17(3):192–201. doi: 10.1136/gut.17.3.192. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Vantrappen G., Ponette E., Geboes K., Bertrand P. Yersinia enteritis and enterocolitis: gastroenterological aspects. Gastroenterology. 1977 Feb;72(2):220–227. [PubMed] [Google Scholar]
  20. Wolfson D. M., Sachar D. B., Cohen A., Goldberg J., Styczynski R., Greenstein A. J., Gelernt I. M., Janowitz H. D. Granulomas do not affect postoperative recurrence rates in Crohn's disease. Gastroenterology. 1982 Aug;83(2):405–409. [PubMed] [Google Scholar]
  21. Woo Z. H., Nygaard K. Small-bowel adaptation after colectomy in rats. Scand J Gastroenterol. 1978;13(8):903–910. doi: 10.3109/00365527809181367. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES