Efficacy and Problems of Fecal Diversion for Intractable Anorectal Complications of Crohn's Disease

Kazutaka Koganei, Hideaki Kimura, Katsuhiko Arai, Akira Sugita and Tsuneo Fukushima

Department of Surgery, Yokohama Citizen's Municipal Hospital

Introduction: The effects of fecal diversion in intractable anorectal complications of Crohn's disease are controversial. Materials and Methods: We studied the efffects of fecal diversion in 42 patients with Crohn's disease (24 men and 18 women) with intractable anorectal complications. Indications for fecal diversion involved with complex perianal fistula (36 patients), anorectal stenosis (22), ano- or rectovaginal fistula (11), rectal fistula (3), perirectal (intrapelvic) abscess (2), rectoperineal fistula (1), and rectourethral fistula (1). Results: After diversion, symptoms improved in 31 of 42 patients, remained unchanged in 4, and worsened in 3. Four patients, improving initially had later recurrence. All rectal fistulas, intrapelvic abscesses, rectoperineal fistulas, and rectourethral fistulas healed, as did 26 of 36 complex fistulas, but most anorectal stenosis and ano- (or recto-) vaginal fistulas did not. Despite improvement, 15 of 16 patients with closure of stoma had recurrent anorectal complications and required rediversion. Overall, only 4 had restored intestinal continuity. Ten needed proctectomy, and 28 remained with fecal diversion. Conclusions: Fecal diversion improves the symptoms of anorectal complications but does not result in healing anorectal lesions and seldom restores intestinal continuity.

Key words
Crohn's disease, anorectal complications, fecal diversion

Reprint requests
Kazutaka Koganei Chronic Intractable Disease Center, Yokohama City University Medical Center
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
March 30, 2005

To read the PDF file you will need Abobe Reader installed on your computer.