title: The role of surgery in the management of patients with refractory chronic granulomatous disease colitis.
abstract: BACKGROUND
  Chronic granulomatous disease is a rare immunodeficiency complicated by dysregulated inflammation and granulomatous complications of the GI tract. The management of chronic granulomatous disease colitis presents the dilemma of an immunocompromised host requiring immunosuppressive therapy which can potentiate fatal infections.
  
  
  OBJECTIVE
  The aim of this study was to identify the types of GI surgery performed in patients and determine the role of surgery in the management of refractory colitis.
  
  
  METHODS
  A retrospective single-institution chart review was performed.
  
  
  METHODS
  Of 268 patients with chronic granulomatous disease treated at the National Institutes of Health between 1985 and 2011, 98 (37%) were identified as having colitis; 27 (10%) had a history of GI luminal surgery.
  
  
  METHODS
  Patient characteristics, type of GI surgery, and clinical outcomes were documented.
  
  
  RESULTS
  A total of 62 GI luminal surgeries were performed in 27 patients with chronic granulomatous disease and colitis. All 27 had a history of perineal disease requiring intervention. Four (15%) had additional surgery performed for reasons other than colitis. Otherwise, 12 (44%) had surgery limited to the perineum, 2 (7%) had a segmental resection, and 13 (48%) underwent fecal diversion with ileostomy or colostomy. Despite local procedures, 7 (58%) patients in the perineal-only group remained symptomatic. Both patients with a segmental resection had persistent perineal disease, and 1 had a recurrent colovesicular fistula. Of the 13 ostomy patients, 11 initially received a diverting ostomy. Eight (73%) of these ultimately required additional procedures for refractory disease, and 4 (36%) developed peristomal pyoderma gangrenosum. Four patients who underwent proctocolectomy with end ileostomy, either initially (2) or as a definitive procedure (2), experienced resolution of colitis and perineal disease.
  
  
  CONCLUSIONS
  This study is limited by its retrospective design, small sample size, and highly selected patient population.
  
  
  CONCLUSIONS
  Proctocolectomy with end ileostomy may offer a definitive treatment in a patient with refractory chronic granulomatous disease colitis given current therapeutic limitations.
authors.affiliation: Surgery Branch, National Cancer Institute, Bethesda, Maryland 20891-1201, USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Alvarez-Downing
authors.forename: Natasha
authors.initials: N
authors.lastname: Kamal
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Inchauste
authors.forename: Sajneet K
authors.initials: SK
authors.lastname: Khangura
authors.forename: Harry L
authors.initials: HL
authors.lastname: Malech
authors.forename: Steven M
authors.initials: SM
authors.lastname: Holland
authors.forename: Marybeth S
authors.initials: MS
authors.lastname: Hughes
authors.forename: Theo
authors.initials: T
authors.lastname: Heller
authors.forename: Richard M
authors.initials: RM
authors.lastname: Sherry
mesh_terms: D015331:Cohort Studies; D003082:Colectomy; D003092:Colitis / Q000209:etiology / Q000601:surgery*; D003106:Colon / Q000601:surgery; D003125:Colostomy; D005260:Female; D006105:Granulomatous Disease, Chronic / Q000150:complications*; D006801:Humans; D007081:Ileostomy; D008297:Male; D010502:Perineum / Q000601:surgery; D017511:Pyoderma Gangrenosum / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome