Me. Lucarotti et al., SYNCHRONOUS PROCTOCOLECTOMY AND ILEOANAL POUCH FORMATION AND THE RISKOF CROHNS-DISEASE, British Journal of Surgery, 82(6), 1995, pp. 755-756
There is controversy on the advisability of one-stage proctocolectomy
and the formation of an ileoanal pouch. Accurate preoperative diagnosi
s is essential to avoid the error of constructing a pouch in a patient
with Crohn's disease. Twenty-four consecutive patients undergoing sub
total colectomy for inflammatory bowel disease were reviewed. All pati
ents had been treated with systemic steroids, 23 were on 5-aminosalicy
lates and 11 on azathioprine. The preoperative diagnoses, based on a c
ombination of clinical features, colonoscopy, barium enema and biopsy
histology, were ulcerative colitis (19), Crohn's disease (four) and in
flammatory bowel disease (unclassified) (one). The final diagnosis was
made on histological examination of the resected specimen. A discrepa
ncy between initial and final diagnosis occurred in eight patients. In
three, the diagnosis was changed from ulcerative colitis to Crohn's d
isease. Three preoperative diagnoses of Crohn's disease were changed t
o ulcerative colitis (one), Behcet's disease (one) and diverticulitis
(one) on final histology. These data suggest that caution should be ex
ercised in performing synchronous proctocolectomy with the formation o
f an ileoanal pouch.