SYNCHRONOUS PROCTOCOLECTOMY AND ILEOANAL POUCH FORMATION AND THE RISKOF CROHNS-DISEASE

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.