Inflamm Bowel Dis. 2023 Mar 1;29(3):417-422. doi: 10.1093/ibd/izac099.

Gassan Kassim ¹, Clara Yzet ¹, Nilendra Nair ¹, Anketse Debebe ¹, Alexa Rendon ¹, Jean-Frédéric Colombel ¹, Cindy Traboulsi ², David T Rubin ², Annalisa Maroli ³, Elisabetta Coppola ³, Michele M Carvello ³, Nadat Ben David ³, Francesca De Lucia ³, Matteo Sacchi ³, Silvio Danese ³, Antonino Spinelli ³, Meike M C Hirdes ⁴, Joren Ten Hove ⁴, Bas Oldenburg ⁴, Aurada Cholapranee ⁵, Maxine Riter ⁶, Dana Lukin ⁷, Ellen Scherl ⁷, Esen Eren ⁸, Keith S Sultan ⁵, Jordan Axelrad ⁸, David B Sachar ¹

Author information

¹Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

²University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA.

³Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy.

⁴Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.

⁵Division of Gastroenterology and Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.

⁶Division of Gastroenterology and Hepatology, Weill Cornell Medical College, NY, USA.

⁷Jill Roberts Center for IBD, Weill Cornell Medicine, NY, USA.

⁸Inflammatory Bowel Disease Center at NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.

Abstract

Background: Many patients with Crohn's disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained excluded rectums.

Methods: We reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up.

Results: From all the CD patients in the institutions' databases, there were 197 who met all our inclusion criteria. A total of 92 (46.7%) of 197 patients ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22(44%) were symptomatic. From our entire cohort of 197 cases, 149 (75.6%) either ultimately lost their rectums or remained symptomatic with retained rectums, while only 28 (14.2%) of 197, and only 4 (5.9%) of 66 with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer.

Conclusions: In this multicenter cohort of patients with CD who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence.