Fecal diversion in perirectal fistulizing Crohn's disease is an underutilized and potentially temporary means of successful treatment

Am Surg. 2009 Aug;75(8):715-8.


The purpose of this study was to determine the outcome of patients treated with fecal diversion for perirectal fistulizing Crohn's disease. Thirty-nine patients were identified and followed for an average of 60 months. Patients were divided into two groups based on surgical treatment: local surgical treatment only and fecal diversion in addition to local surgical therapy. Thirteen patients (33%) underwent fecal diversion due to the severity of their disease. Eleven of these patients (85%) had complete resolution of their fistulas and only two (15%) required proctectomy. In contrast, only five out of 26 patients (19%) who underwent local surgical procedures alone had complete perirectal disease resolution. Intestinal continuity was restored in six patients (46%) and three of these patients (50%) remained disease free. The remaining three patients had disease recurrence, which required additional local procedures in one patient (17%), but with eventual resolution; the other two patients (33%) necessitated rediversion. Our data suggest that fecal diversion is a viable treatment option for severe perirectal fistulizing Crohn's disease and may be associated with a higher rate of resolution than local surgical treatment alone. In addition, we demonstrate a higher rate of successful intestinal continuity restoration than is typically reported.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Cohort Studies
  • Colostomy*
  • Crohn Disease / complications*
  • Crohn Disease / pathology
  • Crohn Disease / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Proctocolectomy, Restorative
  • Rectal Fistula / etiology*
  • Rectal Fistula / pathology
  • Rectal Fistula / surgery*
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult