Crohn's colitis: the fate of the rectum

Previous reports suggest that up to 70% of patients undergoing surgery for Crohn's disease of the large bowel do not have gastrointestinal continuity restored and require a permanent ileostomy. In this study the experience wi th patients requiring surgical treatment of large bowel Crohn's disease is reviewed with particular reference to the management of the rectum. The rec ords of 19 elective and 25 urgent colonic resections performed for large bo wel Crohn's disease in 34 patients (16 males, 28 females; mean age 41 years , range 17-76) between 1983 and 1995 were reviewed. Staged proctectomy was performed in 5 of 12 patients who had colectomy for acute colitis and in on e patient who had had an elective colectomy. Permanent ileostomy was requir ed in 72% of patients with acute Crohn's colitis and 84% of patients who ha d elective surgery for large bower Crohn's. Over 70% of patients having sur gical treatment of Crohn's disease of the large bowel required permanent il eostomy. No cases of cancer developed in patients with retained rectal stum ps.