Download PDF
Clin Colon Rectal Surg 2022; 35(01): 005-009
DOI: 10.1055/s-0041-1740028
Review Article

Fecal Diversion in Complex Perianal Fistulizing Crohn's Disease

Takayuki Yamamoto
1   Inflammatory Bowel Disease Center, Department of Surgery, Yokkaichi Hazu Medical Center, Yokkaichi, Mie, Japan
,
Takahiro Shimoyama
1   Inflammatory Bowel Disease Center, Department of Surgery, Yokkaichi Hazu Medical Center, Yokkaichi, Mie, Japan
› Author Affiliations Funding The authors do not have any financial disclosures or conflict of interest. This research was not supported by any funding agency.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Complex perianal Crohn's disease (CD) remains a challenging problem. Fecal stream is thought to be a trigger of disease progression in patients with CD. In patients with refractory perianal CD, diversion of fecal stream is sometimes required to alleviate clinical symptoms when medical and local surgical management are unsuccessful. Several studies evaluated the outcomes of fecal diversion for complex perianal CD. After fecal diversion, the majority of patients achieved early clinical response, but the prospect of restoring bowel continuity was low (approximately 20%). Nearly half of the patients eventually required proctectomy. A number of studies attempted to identify predictive factors for the outcomes of fecal diversion. Only rectal involvement was associated with unsuccessful restoration of bowel continuity. Biologic therapy did not seem to improve the efficacy of fecal diversion, although the evidence level was low because of insufficient data or methodological limitations. Based on these results, fecal diversion may be useful in alleviating clinical symptoms related to severe perianal CD and avoiding immediate proctectomy. The impact of biologic therapy on the outcomes of fecal diversion should be further investigated.

Keywords

Crohn's disease - perianal Crohn's disease - fecal diversion - proctectomy - biologic therapy


Publication History

Article published online:
17 January 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Schwartz DA, Ghazi LJ, Regueiro M. et al; Crohn's & Colitis Foundation of America, Inc. Guidelines for the multidisciplinary management of Crohn's perianal fistulas: summary statement. Inflamm Bowel Dis 2015; 21 (04) 723-730
    CrossrefPubMedGoogle Scholar
  • 2 Burke JP. Role of fecal diversion in complex Crohn's disease. Clin Colon Rectal Surg 2019; 32 (04) 273-279
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Yamamoto T, Bain IM, Allan RN, Keighley MR. Persistent perineal sinus after proctocolectomy for Crohn's disease. Dis Colon Rectum 1999; 42 (01) 96-101
    CrossrefPubMedGoogle Scholar
  • 4 McIlrath DC. Diverting ileostomy or colostomy in the management of Crohn's disease of the colon. Arch Surg 1971; 103 (02) 308-310
    CrossrefPubMedGoogle Scholar
  • 5 Burman JH, Thompson H, Cooke WT, Williams JA. The effects of diversion of intestinal contents on the progress of Crohn's disease of the large bowel. Gut 1971; 12 (01) 11-15
    CrossrefPubMedGoogle Scholar
  • 6 Orkin BA, Telander RL. The effect of intra-abdominal resection or fecal diversion on perianal disease in pediatric Crohn's disease. J Pediatr Surg 1985; 20 (04) 343-347
    CrossrefPubMedGoogle Scholar
  • 7 Harper PH, Kettlewell MG, Lee EC. The effect of split ileostomy on perianal Crohn's disease. Br J Surg 1982; 69 (10) 608-610
    CrossrefPubMedGoogle Scholar
  • 8 Grant DR, Cohen Z, McLeod RS. Loop ileostomy for anorectal Crohn's disease. Can J Surg 1986; 29 (01) 32-35
    PubMedGoogle Scholar
  • 9 Edwards CM, George BD, Jewell DP, Warren BF, Mortensen NJ, Kettlewell MG. Role of a defunctioning stoma in the management of large bowel Crohn's disease. Br J Surg 2000; 87 (08) 1063-1066
    CrossrefPubMedGoogle Scholar
  • 10 Yamamoto T, Allan RN, Keighley MR. Effect of fecal diversion alone on perianal Crohn's disease. World J Surg 2000; 24 (10) 1258-1262 , discussion 1262–1263
    CrossrefPubMedGoogle Scholar
  • 11 Régimbeau JM, Panis Y, Cazaban L. et al. Long-term results of faecal diversion for refractory perianal Crohn's disease. Colorectal Dis 2001; 3 (04) 232-237
    CrossrefPubMedGoogle Scholar
  • 12 Uzzan M, Stefanescu C, Maggiori L, Panis Y, Bouhnik Y, Treton X. Case series: does a combination of anti-TNF antibodies and transient ileal fecal stream diversion in severe Crohn's colitis with perianal fistula prevent definitive stoma?. Am J Gastroenterol 2013; 108 (10) 1666-1668
    CrossrefPubMedGoogle Scholar
  • 13 Hong MK, Craig Lynch A, Bell S. et al. Faecal diversion in the management of perianal Crohn's disease. Colorectal Dis 2011; 13 (02) 171-176
    CrossrefPubMedGoogle Scholar
  • 14 Sauk J, Nguyen D, Yajnik V. et al. Natural history of perianal Crohn's disease after fecal diversion. Inflamm Bowel Dis 2014; 20 (12) 2260-2265
    CrossrefPubMedGoogle Scholar
  • 15 Gu J, Valente MA, Remzi FH, Stocchi L. Factors affecting the fate of faecal diversion in patients with perianal Crohn's disease. Colorectal Dis 2015; 17 (01) 66-72
    CrossrefPubMedGoogle Scholar
  • 16 Martí-Gallostra M, Myrelid P, Mortensen N, Keshav S, Travis SP, George B. The role of a defunctioning stoma for colonic and perianal Crohn's disease in the biological era. Scand J Gastroenterol 2017; 52 (03) 251-256
    CrossrefPubMedGoogle Scholar
  • 17 Singh S, Ding NS, Mathis KL. et al. Systematic review with meta-analysis: faecal diversion for management of perianal Crohn's disease. Aliment Pharmacol Ther 2015; 42 (07) 783-792
    CrossrefPubMedGoogle Scholar
  • 18 Yamamoto T, Kotze PG, Spinelli A, Panaccione R. Fistula-associated anal carcinoma in Crohn's disease. Expert Rev Gastroenterol Hepatol 2018; 12 (09) 917-925
    CrossrefPubMedGoogle Scholar