title: Natural history of perianal Crohn's disease after fecal diversion.
abstract: BACKGROUND
  Temporary fecal diversion has been used to allow severe perianal Crohn's disease (CD) to heal. Most data on intestinal reconnection rates precede the biological era with limited patient follow-up after reconnection. We, therefore, sought to evaluate the natural history of perianal CD after fecal diversion.
  
  
  METHODS
  We identified 49 patients with CD and perianal involvement who underwent fecal diversion between 1991 and 2011 at a tertiary referral care center. Demographics, medication use, onset and extent of disease, and surgical interventions were abstracted. We determined the percentage of patients who were able to restore intestinal continuity and assessed the sustainability of this reversal. Time to intestinal reconnection and subsequent procedures were determined. We also examined temporal trends in the proportion of patients with perianal CD undergoing diversion or management with seton/EUA/fistulotomy between 2000 and 2011.
  
  
  RESULTS
  Fifteen of 49 patients (31%) reestablished intestinal continuity during the study follow-up period. Ten of 15 patients (67%) who had reestablished intestinal continuity required an additional procedure to divert the fecal stream. Of the 5 patients who remained reconnected, 3 patients required further procedures to control sepsis. The proportion of patients with CD requiring perianal surgical interventions declined between 2000 and 2011.
  
  
  CONCLUSIONS
  Severe perianal CD remains a challenging problem. In patients with CD with perianal disease requiring fecal diversion, the likelihood of sustained intestinal continuity remains low, despite greater biological use. However, there has been a temporal decline in the rate of surgical interventions required for perianal CD from 2000 to 2011.
authors.affiliation: *Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; †Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; and ‡Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jenny
authors.initials: J
authors.lastname: Sauk
authors.forename: Deanna
authors.initials: D
authors.lastname: Nguyen
authors.forename: Vijay
authors.initials: V
authors.lastname: Yajnik
authors.forename: Hamed
authors.initials: H
authors.lastname: Khalili
authors.forename: Gauree
authors.initials: G
authors.lastname: Konijeti
authors.forename: Richard
authors.initials: R
authors.lastname: Hodin
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
authors.forename: Paul
authors.initials: P
authors.lastname: Shellito
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.forename: Joshua
authors.initials: J
authors.lastname: Korzenik
authors.forename: Sonia
authors.initials: S
authors.lastname: Friedman
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001004:Anus Diseases / Q000401:mortality / Q000601:surgery*; D002648:Child; D003424:Crohn Disease / Q000401:mortality / Q000601:surgery*; D005243:Feces; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000401:mortality / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult