ILEOCOLIC RESECTION FOR ACUTE PRESENTATION OF CROHNS-DISEASE OF THE ILEUM

PURPOSE: Traditional therapy for patients with terminal ileitis found at laparotomy for appendicitis has been to perform appendectomy when t he cecum is normal and to leave the diseased ileum in place. METHODS: To determine the role of ileocolic resection in the setting of acute i leitis, records of 1,421 patients with Crohn's disease seen from 1986 to 1994 were retrospectively reviewed. RESULTS: Crohn's disease was fo und at laparotomy for presumed appendicitis in 36 patients (2.5 percen t). Ten patients underwent ileocolic resection, 23 had appendectomy, a nd 3 had exploratory laparotomy alone. One patient whose appendix was removed also had ileocecal bypass. Of the 36 patients, 20 were women a nd 16 were men. Mean age at operation was 24 (range, 11-61) years, and mean follow-up time nas 14 (range, 0.1-49) years. After initial ileoc olic resection, five patients (50 percent) required no further resecti on, with a mean follow-up time of 12.4 (range, 4-19) years. None requi red more than three ileocolic resections, with a mean follow-up time o f 18.1 (range, 4-49) years. Of 26 patients treated traditionally, 24 ( 99 percent) required ileocolic resection for intractability or complic ations of Crohn's disease. Thirty-eight percent required resection wit hin one year and 65 percent within three years (intractability, 8; obs truction, 3; fistula, 4; and perforation, 2). Of 24 patients who subse quently underwent resection, only 6 (25 percent) required further smal l-bower resection for Crohn's disease, with a mean followup time of 13 (range, 0.1-34) years. CONCLUSION: The majority of patients found to have Crohns disease at laparotomy for appendicitis required early ileo colic resection. Therefore, the traditional dictum of nonoperative the rapy for these patients may not be in their best long-term interest an d merits re-evaluation.