Loop ileostomy for anorectal Crohn's disease

The treatment of symptomatic Crohn's disease of the anorectum can be challenging. Medical therapy may fail and local surgery may be complicated by delayed healing or incontinence. The authors report the clinical course of 12 patients with this condition treated by fecal diversion with a loop ileostomy. Seven patients had a rectovaginal fistula. At the time of review, one of them had restored intestinal continuity following successful fistula repair, three had minimal or no symptoms, one had an active perianal fistula after closure of the ileostomy and two had undergone a proctocolectomy for recurrent symptoms. Five patients with Crohn's proctitis or anorectal sepsis were treated by loop ileostomy. One was asymptomatic, one had recurrent symptoms and three underwent a proctocolectomy. From their experience the authors conclude that construction of a loop ileostomy will temporarily improve the symptoms of anorectal Crohn's disease. Fecal diversion does not appear to alter the long-term course of the disease, and successful restoration of intestinal continuity is uncommon.