Crohn's disease of the colon. Is there a role for limited resection?

Forty-one patients underwent resection for Crohn's disease of the large bowel. Twelve patients had a total proctocolectomy for diffuse disease of the colon and rectum, and 29 patients with segmental disease of the large bowel underwent limited resection. Thirteen of the 29 patients had a subtotal colectomy, with 7 patients undergoing immediate ileoproctostomy and 6 having an ileostomy. Further surgery was required in 9 of the 13 patients, and long-term enteric continuity was maintained in only 3 patients. Sixteen patients with more localized Crohn's disease of the colon underwent segmental resection. Seven patients required additional surgery, and enteric continuity was restored in 12 of the 16 patients. There was no mortality among these 29 patients. This study suggests that Crohn's disease of the colon may be successfully treated by limited resection when involvement is segmental. In the patient with more extensive disease of the colon with only rectal sparing, morbidity is high and the probability of maintaining enteric continuity is low. Therefore, in these patients total proctocolectomy should be considered.