Diseases of the Colon & Rectum

, Volume 42, Issue 4, pp 519–524 | Cite as

Perforating ileocecal Crohn's disease does not carry a high risk of recurrence but usually re-presents as perforating disease

  • Takayuki Yamamoto
  • Robert N. Allan
  • Michael R. B. Keighley
Original Contributions


PURPOSE: The aim of this study was to study the natural history of perforating and nonperforating ileocecal Crohn's disease. METHODS: One hundred sixty-five cases of primary ileocecal Crohn's disease operated on between 1975 and 1995 were reviewed. Perforating disease was defined as acute free perforation, subacute perforation with an abscess, or chronic perforation with an internal or external fistula. RESULTS: Perforating disease was identified in 72 patients (44 percent); 11 with acute free perforation, 18 with abscess formation, and 43 with fistulas. Postoperative complications occurred in 29 percent of perforating and in 23 percent of nonperforating disease (not a significant difference). There was no significant difference in the cumulative reoperation-free rate for recurrence at the ileocolonic anastomosis (perforating, 78 percentvs. nonperforating, 73 percent at 5 years and perforating, 61 percentvs. nonperforating, 55 percent at 10 years), or in the median time interval from the primary to the secondary operation (perforating, 49vs. nonperforating, 37 months). Seventy percent of perforating disease re-presented with perforating recurrence. Likewise, 83 percent of nonperforating disease re-presented with nonperforating (P<0.0001) recurrence. Re-reoperation rate for re-recurrence at the ileocolonic anastomosis and median duration from the second operation to the third operation did not differ between perforating and nonperforating disease. Seventy-nine percent of perforating disease re-presented again with perforating disease, and 87 percent of nonperforating disease re-presented again with nonperforating disease as before (P=0.001). CONCLUSIONS: These data suggest that perforating ileocecal disease usually re-presents in the way it did originally but does not represent a high-risk group for recurrence.

Key words

Crohn's disease Perforating disease Nonperforating disease Ileocecal resection Complications Recurrence rate 


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Copyright information

© The American Society of Colon and Rectal Surgeons 1999

Authors and Affiliations

  • Takayuki Yamamoto
    • 1
  • Robert N. Allan
    • 2
  • Michael R. B. Keighley
    • 1
  1. 1.From the University Department of SurgeryQueen Elizabeth HospitalEdgbaston, BirminghamUnited Kingdom
  2. 2.Department of GastroenterologyQueen Elizabeth HospitalEdgbaston, BirminghamUnited Kingdom

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