Recurrent Regional Ileitis after Ileostomy and Colectomy for Granulomatous Colitis

In 31 patients clinical, radiographic and pathological evidence of recurrent regional enteritis developed after ileostomy and colectomy for granulomatous colitis (Crohn's disease of the colon). These represent at least 46 per cent of all cases of granulomatous colitis treated by ileostomy and colectomy at our institution. Eight required multiple operations, and six had severe nutritional deficits. This high rate of recurrent disease and its frequently serious clinical course contrast with recent claims that such consequences are infrequent. Our observations further underline the need for continued separation of the varieties of inflammatory bowel diseases. ALTHOUGH the differentiation between granulomatous colitis (Crohn's disease of the colon) and ulcerative colitis has been widely accepted, a recent study in this journal¹ concludes that the morphologic and clinical distinctions between these two entities “have been too sharply drawn and the grim prognosis often attached to the granulomatous form is not warranted”. Indeed, the authors find it difficult to identify Crohn's disease of the colon completely with regional enteritis because they have found so few small-bowel recurrences after ileostomy and colectomy. Their predictions are that a “total colectomy and ileostomy should then be as successful as in ulcerative colitis.