Periileostomy fistulae in Crohn's disease

Fifteen of 214 patients with an ileostomy constructed during the course of Crohn's disease developed periileostomy fistulae. In each case this was the consequence of recurrent ileal disease. The incidence was higher in female patients as well as those with a prior history of either intraabdominal abscess or any type of fistula. Periileostomy fistulae are frequently multiple. In addition to the clinical features of recurrent disease, periileostomy fistulae cause additional symptoms that are particularly distressing. These result from the proximity of the fistula to the stoma and the difficulty of maintaining the seal of an appliance. All periileostomy fistulae require resection and reconstruction of the stoma. Superficial fistulae with relatively smooth skin around the stoma may be reconstructed using the original stoma site; but deep fistulae with severe peristomal excoriation, induration and inflammation require transposition to a different quadrant. This may, in suitable cases, be carried out by direct stoma-to-stoma transposition, without formal laparotomy. The quality of life following successful reconstruction of the stoma is excellent, even though some patients will develop additional recurrent disease. To date none of these patients have developed another periileostomy fistula.