Abstract
Despite advances in medical therapy for patients with colonic Crohn’s disease, the majority still require operative intervention at some stage if followed up for long enough.1,2 The management of these patients provides a challenge for the surgeon, requiring not only clinical and operative expertise but also the more traditional skill of forming a strong doctor-patient relationship. Careful counselling and the explanation of alternative surgical strategies together with their likely outcome is essential in treating these patients, and this is greatly facilitated by the recent introduction of a multidisciplinary team approach, including stoma therapist, coloproctology specialist nurse and clinical psychologist.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Janowitz HD (1975) Problems in Crohn’s disease, evaluation of the results of surgical treatment. J Chronic Dis 28:63–66.
Elliott PR, Ritchie JK, Lennard-Jones JE (1985) Prognosis of colonic Crohn’s disease. Br Med J 291:178.
Andrews HA, Lewis P, Allan RN (1989) Prognosis after surgery for colonic Crohn’s disease. Br J Surg 76:1184–1190.
Keighley MRB, Allan RN (1986) Current status and influence of operation on perianal Crohn’s disease. Int J Colorectal Dis 1:104–107.
Allan A, Keighley MRB (1988) Management of perianal Crohn’s disease. World J Surg 12:198–202.
Connell WR, Sheffield JR, Kamm MA, Ritchie JK, Hawley PR, Lennard-Jones JE (1994) Lower gastrointestinal malignancy in Crohn’s disease. Gut 35:347–352.
Farmer RG, Hawk WA, Turnbull RB (1975) Clinical patterns in Crohn’s disease: a statistical study of 615 cases. Gastroenterology 68:627.
Greenstein AJ, Kark AE, Dreiling DA (1975) Crohn’s disease of the colon: toxic dilatation of the colon in Crohn’s colitis. Am J Gastroenterol 63:117.
Grieco MB, Bordan DL, Geiss AC, Beil AR (1983) Toxic megacolon complicating Crohn’s colitis. Ann Surg 197:179–182.
Buzzard AJ, Baker WNW, Needham PRG, Warren RE (1974) Acute toxic dilatation of the colon in Crohn’s colitis. Gut 15:416–419.
Goligher JC, Koffman DC, McDombal FT (1970) Surgical treatment of severe attack of ulcerative colitis with special reference to the advantage of early operation. Br Med J iv:703–704.
Travis S, Farrant JM, Ricketts C, Nolan DJ, Mortensen NJMcC, Kettlewell MGW (1996) Predicting outcome in severe ulcerative colitis. Gut 38:905–910.
Truelove SC, Jewell DP (1974) Intensive intravenous regimen for severe attacks of ulcerative colitis. Lancet 1:1067–1070.
Lichtinger S, Present DH, Kornbluth A (1994) Cyclosporin in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 330:1841–1845.
Price AB (1978) Overlap in the spectrum of non-specific inflammatory bowel disease: “colitis indeterminate”. J Clin Pathol 31:567–577.
Flint G, Strauss R, Platt N, Wise L (1997) Ileorectal anastomosis in patients with Crohn’s disease of the colon. Gut 18:236–239.
Fernandez-Herliky L (1959) The articular manifestation of chronic ulcerative colitis: an analysis of 555 cases. N Engl J Med 261:259–263.
Sanitz AM, Greenberg MS (1951) Skin lesions in assocition with colitis. Gastroenterology 19:476–479.
Gelernt IM, Kreel I (1976) Pyoderma gangrenosum in ulcerative colitis: prevention of the gangrenous component. Mt Sinai J Med 43:467–470.
Greenstein AJ, Janowitz MD, Sachar DB (1976) The extraintestinal complications of Crohn’s disease and ulcerative colitis, a study of 700 patients. Medicine 55:401–412.
Billson FA, DeDombal FT, Wilkinson G, Goligher JC (1967) Ocular complications of ulcerative colitis. Gut 8:102–106.
Maratka Z, Nedbal J (1964) Urolithiasis as a complication of the surgical treatment of ulcerative colitis. Gut 5:216–217.
Verbanck J, Lamiere N, Preet M, Pingoin A, Elewnort A, Barbier F (1979) Renal amyloidosis as a complication of Crohn’s disease. Acta Clin Belg 34:6–13.
Werther JL, Shapira A, Rubenstein O, Janowitz HD (1960) Amyloidosis in regional enteritis Am J Med 29:416–423.
Shorvon PJ (1997) Amyloidosis and inflammatory bowel disease. Am J Dig Dis 22:209–213.
Fitchen JH (1975) Amyloidosis and granulomatous ileocolitis. N Engl J Med 292:352–353.
Altman AR, Meltz CR, Janowitz D (1979) Autoimmune haemolytic anaemia in ulcerative colitis. Dig Dis Sei 24:282–285.
Kirshner BS, Klick JR, Kaiman SS (1981) Reversal of growth retardation in Crohn’s disease emphasising oral nutritional restitution. Gastroenterology 80:10–11.
Sugita A, Kogani K, Harada H, Yamazati Y, Fukushima T, Shimada H (1995) Surgery for Crohn’s anal fistula. J Gastroenterol 30:143–146.
Harper PH, Kettlewell MGW, Lee ECG (1982) The effect of split ileostomy on perianal Crohn’s disease. Br J Surg 69:608–610.
Nordgren S, Fasth S, Hulten L (1992) Anal fistulas, incidence and outcome of surgical treatment. Int J Colorectal Dis 7:214–218.
Glotzer DJ (1995) Surgical therapy for Crohn’s disease. Gastroenterol Clin North Am 24:577–596.
Higgins CS, Keighley MRB, Allan RN (1981) Impact of pre-operative weight loss on postoperative morbidity. J R Soc Med 74:571–575.
Irving MH (1990) The management of surgical complications of Crohn’s disease abscess and fistula. In: Allan RN, Keighley MRB, Alexander-Williams J, Hawkin C (eds) Inflammatory bowel disease. Churchill. Livingstone, Edinburgh, pp 489–500.
Mullen JL, Hargrove WC, Dudricks ST, Fitts WT, Rosata EF (1978) Ten year experience with iv hyperalimentation and parenteral nutrition. Ann Surg 187:523–529.
Rombeau JL, Bardot IE, Williamson CE, Mullen JL (1982) Pre-operative TPN and surgical outcome in patients with inflammatory bowel disease. Am J Surg 143:134–143.
Buzby GP (1991) Perioperative total parenteral nutrition in surgical patients. N Engl J Med 325:525.
Detsky AS (1991) Perioperative total parenteral nutrition in surgical patients. N Engl J Med 325:573.
Andrews HA, Keighley MRB, Alexander-Williams J, Allan RN (1991) Strategy for management of distal ileal Crohn’s disease. Br J Surg 78:679–682.
Zelas P, Jagelman DG (1980) Loop ileostomy in the management of Crohn’s colitis in the debil-tated patient. Ann Surg 191:164–168.
Harper PH, Truelove SC, Lee ECG, Kettlewell MGW, Jewell DP (1983) Split ileostomy and ileostomy for Crohn’s disease of the colon: a 20-year survey. Gut 24:106–113.
Alexander-Williams J (1974) Loop ileostomy and colostomy for faecal diversion. Ann R Coll Surg Engl 54:141–148.
Lee ECG (1975) Split ileostomy in the treatment of Crohn’s disease of the colon. Ann R Coll Surg Engl 56:94–102.
Oberhelman HA (1976) The effect of intestinal diversion by ileostomy on Crohn’s disease of the colon. In: Weterman IT, Pena AS, Booth CC (eds) The management of Crohn’s disease. Excerpta Medica, Amsterdam, pp 216–219.
Allan A, Andrews H, Hilton CJ, Keighley MRB, Allan RN, Alexander-Williams J (1989) Segmental colectomy is an appropriate operation for short skip lesions due to Crohn’s disease in the colon. World J Surg 13:611–616.
Ambrose NS, Keighley MRB, Alexander-Williams J, Allan RN (1984) Clinical impact of colectomy and ileo-rectal anastomosis in the management of Crohn’s disease. Gut 25:223–227.
Keighley MRB, Buchmann P, Lee JR (1982) Assessment of anorectal function in selection of patients for ileo-rectal anastomosis in Crohn’s colitis. Gut 23:102–107.
Lefton HB, Farmer RG, Fazio V (1975) Ileorectal anastomosis for Crohn’s disease of the colon. Gastroenterology 69:612–617.
Allan RN, Steinberg DM, Alexander-Williams J, Cook WT (1977) Crohn’s disease involving the colon: an audit of clinical management. Gastroenterology 73:723–732.
Buckmann P, Weterman IT, Keighley MRB, Pena AS, Allan RN, Alexander-Williams J (1981) The prognosis of ileo-rectal anastomosis in Crohn’s disease. Br J Surg 68:7–10.
Cooper JC, Jones D, Williams NS (1986) Outcome of colectomy and ileorectal anastomosis in Crohn’s disease. Ann R Coll Surg Engl 68:279–282.
Scammell BE, Keighley MRB (1985) Delayed perineal wound healing after proctectomy for Crohn’s colitis. Br J Surg 73:150–152.
Fazio VW, Floriano-Marcettis J, Church JM et al. (1996) Effect of resection margins on the recurrence of Crohn’s disease in the small bowel. Ann Surg 224:563–573.
Ihasz M, Batorfi I, Balint A et al. (1995) Surgical relations of Crohn’s disease and the frequency of recurrence. Acta Chir Hung 35:63–75.
Post S, Herfarth, Bohm E et al. (1996) The impact of disease pattern, surgical management and individual surgeons on the risk for relaparotomy for recurrent Crohn’s disease. Ann Surg 223:253–260.
Goldberg PA, Wright JP, Gerber M, Classen R (1993) Incidence of surgical resection for Crohn’s disease. Dis Colon Rectum 36:736–739.
D’Haens GR, Rutgeerts P (1994) Post-operative recurrence of Crohn’s disease, pathogenesis and prevention. Acta Gastroenterol Belg 57:311–313.
Aeberhard P, Berchtold W, Riedtmann HJ, Stadelman G (1996) Surgical recurrence of perforating and non-perforating Crohn’s disease. Dis Colon Rectum 39:80–87.
Raab Y, Bergstron R, Ejerblad J, Graf W, Pahlman L (1996) Factors influencing recurrence in Crohn’s disease. Dis Colon Rectum 39:918–925.
Sachar DB (1996) Patterns of postoperative recurrence in fistulizing and stenotic Crohn’s disease. Clin Gastroenterol 22:114–116.
Holzheimer RG, Molloy RG, Witman DH (1995) Post-operative complications predict recurrence of Crohn’s disease. Eur J Surg 161:129–135.
Smedh K, Olaison G, Nystrom PO, Sjondahl R (1993) Intra-operative enteroscopy in Crohn’s disease. Br J Surg 80:897–900.
Shivananda S, Mordijk ML, Pena AS, Mayberry JF (1989) Crohn’s disease, risk of recurrence and re-operation in a defined population. Gut 30:990–998.
Souftly A, Myren J, Clamp SE, Bouchier IA, Watkinson G, da Dombal FT (1988) Affecting recurrence after surgery for Crohn’s disease. Scand J Gastroenterolgy (Suppl) 144:31–34.
Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts J L, Coremans G (1984) Natural history of recurrent Crohn’s disease at the ileocaecal anastomosis after curative surgery. Gut 25:665–672.
Rutgeerts, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M (1990) Predictability of the post-operative course of Crohn’s disease. Gastroenterology 99:956–963.
Pallona, Boirivant M, Stazi MA, Coslintino R, Prentera C, Torsoli A (1992) Analysis of clinical course of post-operative recurrence in Crohn’s disease of the distal ileum. Dig Dis Sci 37:215–219.
Tytgat GNJ, Ulder CJ, Brummelkemp WH (1988) Endoscopic lesions in Crohn’s disease early after ileo-caecal resection. Endoscopy 20:260–262.
Brignola C, Cottone M, Pena A, Italian Co-operative Study Group (1985) Mesalamine in the prevention of endoscopic recurrence after intestinal resection for Crohn’s disease. Gastroenterology 108:345–349.
Caprilli R, Corrao G, Taddei G, Torselli F, Torchio P, Viscido A, Gruppo Italiano per lo Studio Del Colon E Del Retto (1996) Prognostic factors for post-operative recurrence of Crohn’s disease. Dis Colon Rectum 39:335–341.
McLeod RS, Wolff BG, Steinhart AM et al (1995) Prophylactic mesalamine treatment decreases post-operative recurrence of Crohn’s disease. Gastroenterology 109:404–413.
Cottone M, Rosselli M, Orlando A (1994) Smoking habits and recurrence in Crohn’s disease. Gastroenterology 106:643–648.
Ritchie JK (1996) The results of surgery for large bowel Crohn’s disease. Ann R Coll Surg Engl 72:155–157.
Scammell BE, Ambrose NS, Alexander-Williams J, Allan RN, Keighley MRB (1985) Recurrent small bowel Crohn’s disease is more frequent after subtotal colectomy and ileorectal anastomosis than proctocolectomy. Dis Colon Rectum 28:770–771.
Wettergren A, Christiansen J (1991) Risk of recurrence and re-operation after resection for ileocolic Crohn’s disease. Scand J Gastroenterol 26:1319–1322.
Cameron JL, Hamilton SR, Coleman J, Sitzmann JV. Bayless TM (1992) Patterns of ileal recurrence in Crohn’s disease, a prospective randomised study. Ann Surg 215:546–551.
Scott NA, Sueling HM, Hughes LE (1995) Anastomotic configuration does not affect recurrence of Crohn’s disease after ileo-colonic resection. Int J Colorectal Dis 10:67–69.
Ludwig KA, Milsom JW, Church JM, Fazio VW (1996) Preliminary experience with laparoscopic intestinal surgery for Crohn’s disease. Am J Surg 171:52–56.
Sizawa H, Hibi T, Ohishi T et al. (1996) Laparoscopic assisted ileocaecal resection for Crohn’s disease associated with intestinal stenosis and ileovesical fistula. J Gastroenterol 31:425–430.
Panis Y, Popard B, Nemeth J, Lavergne A, Heutofeville P, Valleur P (1996) Ileal pouch anal anastomosis for Crohn’s disease. Lancet 347:854–857.
Deutche A, McLeod RS, Cullen J, Cohen Z (1991) Results of the pelvic pouch procedure in patients with Crohn’s disease. Dis Colon Rectum 34:475–477.
Nicholls RJ (1987) Restorative proctolectomy with various tyres of reservoir. World J Surg 11:751–762.
Hymen HH, Fazio VW, Tuckson WB, Lavery IC (1991) The consequences of ileal pouch-anal anastomosis for Crohn’s disease. Dis Colon Rectum 34:653–657.
Poppen B, Svenberg T, Bark T (1992) Colectomy: proctomucosectomy with S pouch: operative procedures complications and functional outcome in 69 consective patients. Dis Colon Rectum 32:40–47.
Price AB (1996) Indeterminate colitis; broadening the prospective. Curr Diagn Pathol 3:35–44.
Pezim ME, Pemberton JH, Beart KW (1989) outcome of “indeterminate colitis” following ileal pouch-anal anastomosis. Dis Colon Rectum 32:653–658.
Wells AD, McMillan I, Price AB, Ritchie JK, Nicholls RJ (1991) Natural history of indeterminate colitis. Br J Surg 78:179–181.
Marcellow PW, Shoetz DJ, Roberts PL et al. (1996) Evolutionary changes in pathologic diagnosis following the ileoanal pouch procedure. Int J Colorectal Dis 1996:11:145.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2000 Springer-Verlag London Limited
About this chapter
Cite this chapter
Allan, A., Bearn, P.E. (2000). The Surgical Management of Crohn’s Disease of the Colon. In: Beynon, J., Carr, N.D. (eds) Recent Advances in Coloproctology. Springer, London. https://doi.org/10.1007/978-1-4471-0731-6_4
Download citation
DOI: https://doi.org/10.1007/978-1-4471-0731-6_4
Publisher Name: Springer, London
Print ISBN: 978-1-4471-1190-0
Online ISBN: 978-1-4471-0731-6
eBook Packages: Springer Book Archive