An Australian experience of Crohn's disease

A computer analysis has been made of the clinical experience of Crohn's disease of one of the authors (E.S.R.H.) (1950-78: 50 patients) and of the Alfred Hospital Medical staff, Melbourne (1959-78: 39 patients). The mean follow-up period for the combined data was 6.2 years. Sixty-two of the 89 patients were female and 27 male. The small intestine was involved in 24 patients, the large intestine in 21, and both small and large intestine in 44. Symptoms were related to the anatomical localization of the disease. Four patients have died (two postoperative deaths and two unrelated to Crohn's disease). Sixty-nine of the 89 patients required an operative procedure, and 53 underwent one or more definitive operations with curative intention. A total of 165 operations were performed, 88 of which were definitive. Thirty-four patients developed recurrence, defined to include reactivation of disease in intestinal segments left in situ. Ten patients developed two or more recurrences. Multiple recurrences were most frequent after operation for combined small and large intestinal Crohn's disease. No patient with large-intestinal Crohn's disease alone developed more than one recurrence. Each patient undergoing subtotal colectomy and ileorectal anastomosis (six patients) or ileostomy (nine patients) required one or more further definitive operations. Recurrence was more frequent after the first than the second definitive operation (P = 0.02), the median recurrence-free intervals being 12 and 23 months respectively.