Surgery for acute Crohn's colitis: results and long term follow-up

Acute Crohn's disease of the colon requiring emergency surgery is uncommon, but may be increasing in frequency. Between 1954 and 1981, 215 patients had surgery for acute inflammatory bowel disease at St. Mark's Hospital, and of these 18 had acute Crohn's colitis. There was one postoperative death, and the remaining patients were followed up for an average of 8 years. Ten patients had toxic dilation, two a toxic dilation with free perforation, three had perforation without dilatation and in three surgery was required for an acute deterioration. Surgical treatment included proctocolectomy (one), colectomy and ileostomy (fourteen), colectomy and ileorectal anastomosis (two) and defunctioning ileostomy alone (one). Subsequent rectal excision was necessary in ten of sixteen patients. Acute colonic Crohn's disease requiring surgery is less likely than ulcerative colitis to be amenable to restorative surgery despite a policy of rectal conservation.