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P314 Long-term fate of the excluded rectum in Crohn’s disease

C. Yzet*1, G. Kassim2, N. Nair2, J-F. Colombel2, D. B. Sachar2

1Amiens university hospital, Amiens, France, 2Icahn School of Medicine at Mount Sinai, Division of Gastroenterology, New York, USA

Background

Faecal diversion with ostomy construction is performed in nearly 10% of Crohn’s disease (CD) patients, often for refractory perineal disease. The long-term fate of these retained rectums has not been extensively studied; hence, we undertook a retrospective review of the outcomes of a cohort of CD patients with excluded, retained rectums.

Methods

A data base of all CD patients followed at The Mount Sinai Hospital was searched for those who had undergone initial rectal exclusion surgery between 1990 and 2014, and who retained the excluded rectums for at least 6 months. We then retrieved electronic records to determine the last-recorded outcomes of these rectums, whether removed, reconnected, or still excluded.

Results

Among 910 CD patients in the Mount Sinai Hospital Data Warehouse, we identified 91 who met all criteria for rectums retained for at least 6 months following original stomal diversion. Follow-up data (mean 9 year, [range 3.4–13.9]) were available for 81 (89%). Forty-five (56%) of these patients were female. Perineal disease had been noted preoperatively in 44 (54%) cases. The median age at the time of faecal diversion was 34 year (26–44). Although some patients had multiple indications, the primary reasons for rectal exclusion were perineal disease in 32%, acute or refractory bowel disease in 32%, internal fistula in 15%, bowel stricture in 8.6%, colon cancer in 2.5%, and unclear in 9.9%. At the time of last follow-up, 37 patients (46%) had undergone excision of the rectum. Among the 37 patients who underwent total proctectomy, the principal indications were clinicians’ concerns regarding inadequate surveillance (43%), worsening perineal fistulisation (32%), extensive soiling (19%), one case of anal cancer (2.7%), and one case of rectal dysplasia (2.7%). Among the 44 patients who still had retained rectums, 19 (54%) had been reconnected) and 12 of these (63%) were known free of symptoms. Of the 25 patients with retained excluded rectums, only 9 (36%) were symptom-free; the remainder had fistulae (24%), perianal irritation (20%), and one each (4%) stenosis, sexual difficulty, and anal cancer.

Conclusion

Among 81 CD patients with long-term excluded rectums, only 44 (54%) still had their rectums in situ after a mean 9-year follow-up. Of these, only 21 (48%) were symptom-free. Two patients among the 81 (2.5%) developed anal cancer.