Perforating and nonperforating Crohn's disease. An unpredictable guide to recurrence after surgery.
Four hundred eighty-six patients who have had resections for Crohn's disease at the Cleveland Clinic were reviewed. The patients were categorized by indication for surgery into three groups: perforating (P) (135 patients), nonperforating (NP) (278 patients), and miscellaneous (M) (77) patients. One hundred ninety-four patients had two or more resections and 56 underwent a third resection. Patients were no more likely to have the same indication for surgery at the time of the second resection (P = 25 percent; NP = 44 percent; M = 57 percent) or the third resection (P = 11 percent; NP = 65 percent; M = 55 percent). There was also no difference in the interval between resections for the P and NP groups. The lack of agreement between resections suggests that the categorization of patients into P and NP groups does not facilitate prediction of the nature of recurrent disease. The concept of aggressive perforating and indolent nonperforating Crohn's is not substantiated by this study.
McDonald
P J
PJ
Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44106.
Fazio
V W
VW
Farmer
R G
RG
Jagelman
D G
DG
Lavery
I C
IC
Ruderman
W B
WB
Easley
K A
KA
Harper
P H
PH
D000328:Adult; D003424:Crohn Disease / Q000601:surgery*; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation