title: Fecal diversion in perirectal fistulizing Crohn's disease is an underutilized and potentially temporary means of successful treatment.
abstract: The purpose of this study was to determine the outcome of patients treated with fecal diversion for perirectal fistulizing Crohn's disease. Thirty-nine patients were identified and followed for an average of 60 months. Patients were divided into two groups based on surgical treatment: local surgical treatment only and fecal diversion in addition to local surgical therapy. Thirteen patients (33%) underwent fecal diversion due to the severity of their disease. Eleven of these patients (85%) had complete resolution of their fistulas and only two (15%) required proctectomy. In contrast, only five out of 26 patients (19%) who underwent local surgical procedures alone had complete perirectal disease resolution. Intestinal continuity was restored in six patients (46%) and three of these patients (50%) remained disease free. The remaining three patients had disease recurrence, which required additional local procedures in one patient (17%), but with eventual resolution; the other two patients (33%) necessitated rediversion. Our data suggest that fecal diversion is a viable treatment option for severe perirectal fistulizing Crohn's disease and may be associated with a higher rate of resolution than local surgical treatment alone. In addition, we demonstrate a higher rate of successful intestinal continuity restoration than is typically reported.
authors.affiliation: Division of Colon and Rectal Surgery, University of South Florida, Tampa, Florida, USA. krehg@health.usf.edu
authors.forename: Kellee L
authors.initials: KL
authors.lastname: Rehg
authors.forename: Jaime E
authors.initials: JE
authors.lastname: Sanchez
authors.forename: Beth R
authors.initials: BR
authors.lastname: Krieger
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Marcet
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003125:Colostomy; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D012003:Rectal Fistula / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult