Late onset Crohn's disease in patients with colonic diverticulitis

Summary and Conclusions

Twenty-five patients had Crohn's disease in a colonic specimen resected for presumed diverticulitis. A syndrome of combined diverticulitis and Crohn's colitis is presented, which is heralded by anotectal disease, rectal bleeding, and fistulas. The illness is characterized by multiple operations, failure of diversionary procedures to control distal disease, and a high incidence of lethal pelvic sepsis. Results of these patients' studies suggest that late onset Crohn's colitis should be considered when clinical diverticulitis is present associated with anorectal disease (past or present), rectal bleeding, fistulas, or exceptional difficulty with an initial resection for diverticulitis. Patients with persistence of disease after colonic resection, distal recurrence after diversion, or late fistulization after resection for diverticulitis should be considered to have Crohn's colitis until proved otherwise. Also, patients requiring multiple resections for clinical diverticulitis are also strongly suspect for Crohn's colitis. When significant anorectal disease is present and Crohn's colitis is either proved or suspected, proctocolectomy may be warranted.