Diseases of the Colon & Rectum

, Volume 23, Issue 7, pp 492–497 | Cite as

Results of operative management of Crohn’s disease: A series of 50 patients managed by one surgeon

  • F. T. McDermott
  • E. S. R. Hughes
  • E. A. Pihl
  • B. J. Milne
  • A. B. Price


A computer analysis has been made of clinical experience of Crohn’s disease in Australian patients. Between 1950 and 1978, 50 patients were managed for Crohn’s disease by one of the authors (E.S.R.H.). This group represented 3.1. per cent of 1608 patients treated during the same period for primary inflammatory bowel disease. The mean follow-up period was 8.4 years. Thirty-nine of the 50 patients were female and 11 male. The small intestine was involved in seven patients, large intestine in 17 and both small and large intestine in 26. Symptoms were related to the anatomic localization of disease. Four patients have died (two postoperative deaths and two unrelated to Crohn’s disease). Forty-nine of the 50 patients required operative procedures and 36 underwent one or more definitive operations with curative intention. A total of 124 operations was performed, 70 of which were definitive. Twenty-nine of the 36 patients managed by a definitive operation developed recurrence, defined to include reactivation of disease in intestinal segments leftin situ. Ten patients developed two or more recurrences. Multiple recurrences were most frequent after operation for combined small- and large-intestinal Crohn’s disease. No patient with large-intestinal Crohn’s disease alone developed more than one recurrence. Each patient undergoing subtotal colectomy with ileorectal anastomosis (six patients) or ileostomy (nine patients) required one or more further definitive operations. Recurrence was more frequent after the first than second definitive operation (P=0.007), the median recurrence-free intervals being 11 and 23 months, respectively.

Key words

Crohn’s disease Epidemiology, Crohn’s disease management Intestine(s), large, small 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kyle J. An epidemiological study of Crohn’s disease in Northeast Scotland. Gastroenterology 1971;61:826–33.PubMedGoogle Scholar
  2. 2.
    Smith IS, Young S, Gillespie G, O’Connor J, Bell JR. Epidemiological aspects of Crohn’s disease in Glydesdale 1961–70. Gut 1975;16:62–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Weterman IT: Crohn’s disease—a global assessment; International Gastroenterology Workshop. Cape Town. South Africa: Oxford, 1980 (in press)Google Scholar
  4. 4.
    Brahme F, Lindström C, Wenckert A, Crohn’s disease in a defined population: an epidemiological study of incidence, prevalence, mortality, and secular trends in the city of Malmö, Sweden. Gastroenterology 1975;69:342–51.PubMedGoogle Scholar
  5. 5.
    Hellers G. Crohn’s disease in Stockholm County 1955–1974: a study of epidemiology, results of surgical treatment and long-term prognosis. Acta Chir Scand 1979;suppl 490:1–84.Google Scholar
  6. 6.
    Failes D. Crohn’s disease. Med J Aust 1970;2:265–8.PubMedGoogle Scholar
  7. 7.
    Fone DJ. Regional Enteritis (Crohn’s disease). Med J Aust 1966;1:865–73.Google Scholar
  8. 8.
    McGovern VJ, Goulston SJ. Crohn’s disease of the colon. Gut 1968;9:164–76.PubMedCrossRefGoogle Scholar
  9. 9.
    Selby WS, Kater RM, Heap TR, Gallagher ND. Crohn’s disease: a review of 122 cases. Aust NZ J Med 1979;9:145–50.Google Scholar
  10. 10.
    Nie NH, Bent DH, Hull CH. SPSS: statistical package for the social sciences. New York: McGraw Hill, 1970.Google Scholar
  11. 11.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat A 1958;53:457–81.CrossRefGoogle Scholar
  12. 12.
    Gehan EA. A generalized Wilcoxon test for comparing arbitrarily singly-censored samples. Biometrika 1965;52:203–23.PubMedGoogle Scholar
  13. 13.
    Farmer RG, Hawk WA, Turnbull RB Jr. Clinical patterns in Crohn’s disease: a statistical study of 615 cases. Gastroenterology 1975;68:627–35.PubMedGoogle Scholar
  14. 14.
    Goligher JC, De Dombal FT, Burton I. Surgical treatment and its results. In: Engel A, Larsson T, eds. Skandia international symposium: regional enteritis (Crohn’s disease); 5th Stockholm, 1970. Stockholm: Nordiska Bokhandelns Förlag, 1971:166–76.Google Scholar
  15. 15.
    Truelove SC, Pena AS. Course and prognosis of Crohn’s disease. Gut 1976;17:192–201.PubMedCrossRefGoogle Scholar
  16. 16.
    Krause E. Epidemiology in Sweden. In: Engel A, Larsson T, eds. Skandia international symposium; regional enteritis (Crohn’s disease): 5th Stockholm, 1970. Stockholm: Nordiska Bokhandelns Förlag, 1971;142–51.Google Scholar
  17. 17.
    Young S, Smith IS, O’Connor J, Bell JR, Gillespie G. Results of surgery for Crohn’s disease in the Glasgow region. 1961–1970. Br J Surg 1975;62:528–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Crohn BB, Yarnis H. Regional ileitis. 2nd ed. New York, Grune & Stratton, 1958.Google Scholar
  19. 19.
    Monk M, Mendeloff AE, Siegel CI, Lilienfeld A. An epidemiological study of ulcerative colitis and regional enteritis among adults in Baltimore. I. Hospital incidence and prevalence, 1960 to 1963. Gastroenterology, 1967;53:198–210.Google Scholar
  20. 20.
    Farmer RG, Hawk WA, Turnbull RB Jr. Indications for surgery in Crohn’s disease: analysis of 500 cases. Gastroenterology 1976;71:245–50.PubMedGoogle Scholar
  21. 21.
    De Dombal FT. The results of surgical treatment for Crohn’s disease. Br J Surg 1972;59:826–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Prior P, Fielding JF, Waterhouse JA, Cooke WT. Mortality in Crohn’s disease. Lancet 1970;1:1135–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Greenstein AJ, Sachar DB, Pasternack BS, Janowitz HD. Reoperation and recurrence in Crohn’s colitis and ileocolitis: crude and cumulative rates. N Engl J Med 1975;293:685–90.PubMedGoogle Scholar
  24. 24.
    Goligher JC. The outcome of excisional operations for primary and recurrent Crohn’s disease of the large intestine. Surg Gynecol Obstet 1979;148:1–8.PubMedGoogle Scholar
  25. 25.
    Goligher JC, De Dombal FT, Burton I. Crohn’s disease, with special reference to surgical management. Prog Surg 1972;10:1–23.PubMedGoogle Scholar
  26. 26.
    De Dombal FT, Burton I, Goligher JC. The early and late results of surgical treatment for Crohn’s disease. Br J Surg 1971;58:805–16.PubMedCrossRefGoogle Scholar
  27. 27.
    Hughes ES, McDermott FT, Masterton JP. Ileorectal anastomosis for inflammatory bowel disease: 15-year follow-up. Dis Colon Rectum 1979;22:399–400.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1980

Authors and Affiliations

  • F. T. McDermott
    • 1
    • 2
    • 3
  • E. S. R. Hughes
    • 1
    • 2
    • 3
  • E. A. Pihl
    • 1
    • 2
    • 3
  • B. J. Milne
    • 1
    • 2
    • 3
  • A. B. Price
    • 1
    • 2
    • 3
  1. 1.Department of SurgeryMonash University, Alfred HospitalPrahranAustralia
  2. 2.Department of Pathology and ImmunologyMonash University, Alfred HospitalPrahranAustralia
  3. 3.Department of Computer CentreMonash UniversityPrahranAustralia

Personalised recommendations