Total colectomy for Crohn's disease

Background: Total colectomy for Crohn's disease of the colon may be restora tive with ileorectal anastsmosis or with an ileostomy and rectal stump. The present paper retrospectively audits the results of total colectomy and in particular assesses the number of patients who had a permanent ileostomy a nd whether this was related to disease in the rectum at the time of the ori ginal operation. Methods: A retrospective case note review was undertaken of patients operat ed upon between 1968 and 1994. Results: Thirty-eight patients were identified (mean age 35 years, range 17 -65 years). One patient died perioperatively from an anastomotic leak, Medi an follow-up for the remaining patients was 7 years (range 1-29 years). Ile orectal anastomosis was performed in 17 patients and total colectomy and il eostomy in 20 patients. Indications for surgery were failure of medical tre atment (61%); toxic colitis (18%); abscess (8%); perforation (5%); large bo wel obstruction (5%); and colovesical fistula (3%). Subsequent proctectomy (14 patients, 38%) was more likely with subtotal colectomy and ileostomy (n ine patients, 45%) than ileorectal anastomosis (five patients, 29%). This w as not statistically significant (P = 0.33). Additionally, seven patients h ad diversion of the rectum making 21 with an ileostomy (57%). Rectal involv ement at the time of the original procedure significantly increased the lik elihood of permanent ileostomy (P = 0.001). The presence of anal disease di d not increase the prospect of ileostomy. One patient died with advanced ad enocarcinoma in a defunctioned rectum. Conclusions: A permanent ileostomy after total colectomy for Crohn's diseas e is common and significantly more likely with rectal involvement.