Proximal recurrence and the fate of the rectum following excisional surgery for Crohn's disease of the large bowel.

One-hundred-twenty-seven patients with Crohn's disease of the large bowel underwent excisional surgery with the establishment of an ileostomy at the Cleveland Clinic between 1955 and 1973; the distribution of disease at this initial resection could be accurately determined. A mean follow-up period of 11 1/2 years has shown that the overall incidence of recurrence requiring resection was 27% and the cumulative risk of recurrence determined by actuarial methods was 44% (+/- 10.6%) at 19 years. Initial involvement of the terminal ileum in addition to the large bowel was associated with a significantly higher incidence of overall recurrence (p less than 0.05) and earlier postoperative recurrence (46% +/- 9% at 11 years), when compared with patients who had ileal sparing (23% +/- 5% at 11 years). This suggests that involvement of the terminal ileum in patients with Crohn's disease of the large bowel may be of prognostic importance. Of 101 patients who had a subtotal colectomy with rectal preservation, 58 subsequently underwent either rectal excision (46 patients), ileorectal anastomosis (six patients) or both of these operations (six patients); this high incidence of reoperation should not be confused with recurrence.