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Gut. Jun 1984; 25(6): 665–672.
PMCID: PMC1432363

Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery.

Abstract

An endoscopical and histological study was carried out in 114 patients, treated by 'curative' resection of the terminal ileum and part of the colon for Crohn's disease, in order to study the natural history of recurrent Crohn's disease. The recurrence rate of Crohn's disease in patients examined within one year of the operation was 72%. This figure did not differ significantly from that in patients examined one to three years or three to 10 years after surgery (79% and 77% respectively). Recurrence was located in the neoterminal ileum and at the anastomosis in 88% of the patients. Early endoscopic signs of recurrence were small aphthous ulcers in the neoterminal ileum. Ileal biopsies at this stage showed an important inflammatory cell infiltrate of the lamina propria with numerous eosinophils and fusion and blunting of the villi. More advanced lesions observed in patients examined one to three years after surgery, consisted of larger, often serpiginous ulcerations and nodular thickening of folds. In patients examined three to 10 years after the operation, the anastomosis was frequently stenosed and rigid, with large ulcers extending from the stenosis into the colon. Mucosal granulomas may be found in normal appearing mucosa as well as in the obviously inflamed mucosa surrounding the ulcers. These studies suggest that recurrence of Crohn's disease almost always develops in the first year after the operation. Significant endoscopic lesions may be present without clinical symptoms, particularly in the earlier stages of the disease.

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Selected References

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  • Lennard-Jones JE, Stalder GA. Prognosis after resection of chronic regional ileitis. Gut. 1967 Aug;8(4):332–336. [PMC free article] [PubMed]
  • Atwell JD, Duthie HL, Goligher JC. The outcome of Crohn's disease. Br J Surg. 1965 Dec;52(12):966–972. [PubMed]
  • Barber KW, Waugh JM, Beahrs OH, Sauer WG. Indications for and the Results of the Surgical Treatment of Regional Enteritis. Ann Surg. 1962 Sep;156(3):472–480. [PMC free article] [PubMed]
  • De Dombal FT, Burton I, Goligher JC. Recurrence of Crohn's disease after primary excisional surgery. Gut. 1971 Jul;12(7):519–527. [PMC free article] [PubMed]
  • Nugent FW, Veidenheimer MC, Meissner WA, Haggitt RC. Prognosis after colonic resection for Crohn's disease of the colon. Gastroenterology. 1973 Sep;65(3):398–402. [PubMed]
  • 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 Oct 2;293(14):685–690. [PubMed]
  • Truelove SC, Pena AS. Course and prognosis of Crohn's disease. Gut. 1976 Mar;17(3):192–201. [PMC free article] [PubMed]
  • KIEFER ED, MARSHALL SF, BROLSMA MP. The management of chronic regional ileitis. Gastroenterology. 1950 Jan;14(1):118–130. [PubMed]
  • Geboes K, Vantrappen G. The value of colonoscopy in the diagnosis of Crohn's disease. Gastrointest Endosc. 1975 Aug;22(1):18–23. [PubMed]
  • Lee EC, Papaioannou N. Recurrences following surgery for Crohn's disease. Clin Gastroenterol. 1980 May;9(2):419–438. [PubMed]
  • Vantrappen G, Ponette E, Geboes K, Bertrand P. Yersinia enteritis and enterocolitis: gastroenterological aspects. Gastroenterology. 1977 Feb;72(2):220–227. [PubMed]
  • Rutgeerts P, Geboes K, Ponette E, Coremans G, Vantrappen G. Acute infective colitis caused by endemic pathogens in western Europe: endoscopic features. Endoscopy. 1982 Nov;14(6):212–219. [PubMed]
  • Woo ZH, Nygaard K. Small-bowel adaptation after colectomy in rats. Scand J Gastroenterol. 1978;13(8):903–910. [PubMed]
  • Bechi P, Romagnoli P, Cortesini C. Ileal mucosal morphology after total colectomy in man. Histopathology. 1981 Nov;5(6):667–678. [PubMed]
  • Glass RE, Baker WN. Role of the granuloma in recurrent Crohn's disease. Gut. 1976 Jan;17(1):75–77. [PMC free article] [PubMed]
  • Chambers TJ, Morson BC. The granuloma in Crohn's disease. Gut. 1979 Apr;20(4):269–274. [PMC free article] [PubMed]
  • Pennington L, Hamilton SR, Bayless TM, Cameron JL. Surgical management of Crohn's disease. Influence of disease at margin of resection. Ann Surg. 1980 Sep;192(3):311–318. [PMC free article] [PubMed]
  • Wolfson DM, Sachar DB, Cohen A, Goldberg J, Styczynski R, Greenstein AJ, Gelernt IM, Janowitz HD. Granulomas do not affect postoperative recurrence rates in Crohn's disease. Gastroenterology. 1982 Aug;83(2):405–409. [PubMed]
  • Goligher JC. Inflammatory disease of the bowel: results of resection for Crohn's disease. Dis Colon Rectum. 1976 Oct;19(7):584–587. [PubMed]
  • Farmer RG, Hawk WA, Turnbull RB., Jr Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology. 1975 Apr;68(4 Pt 1):627–635. [PubMed]
  • Koch TR, Cave DR, Ford H, Kirsner JB. Crohn's ileitis and ileocolitis: a study of the anatomical distribution of recurrence. Dig Dis Sci. 1981 Jun;26(6):528–531. [PubMed]

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