The effect of intra-abdominal resection or fecal diversion on perianal disease in pediatric Crohn's disease

To determine whether perianal Crohn's disease responds to resection of active intra-abdominal disease or to diversion, 273 cases of Crohn's disease in children (ages 4 to 18 years) were reviewed (all had been seen between 1970 and 1983). Of these, 104 patients underwent an intestinal operation, and 42 of the 104 (40%) had documented perianal disease at the time of their operation. Follow-up averaged 8 3/4 years from time of diagnosis. Three of the 42 died, at 1, 3, and 5 months postoperatively (mortality, 7%) and one was unavailable for follow-up. In these 42 patients with active perianal disease, an intestinal resection with primary anastomosis was performed in 19; one died postoperatively and one was unavailable for follow-up. Of the remaining 17 patients, five (29%) improved and 12 (71%) had continued perianal disease, either without change or worse. At least one further intestinal resection was needed in five of the 17 and two have needed proctocolectomy. A defunctionalizing procedure was done as part of the initial operation in 11 of the 42 patients. Two showed improvement; however, both needed proctocolectomy for rectal disease, and none of the 11 with fecal diversion have had reestablishment of intestinal continuity. In 12 of the 42 patients proctocolectomy was the initial procedure, usually for severe rectosigmoid disease. Of 38 children followed, 20 had proctocolectomy, 11 initially and nine after lesser procedures; overall rate of proctocolectomy was 53%. Resection of active intra-abdominal disease is not necessarily followed by resolution of perianal lesions. Defunctionalizing the rectum with fecal diversion does not appear to alter perianal disease. A significant portion (53%) of pediatric patients who had perianal Crohn's disease and required intestinal resection eventually required proctocolectomy, usually because of severe rectosigmoid disease.