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Postoperative diagnostic revision for Crohn disease after subtotal colectomy for inflammatory bowel disease

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Subtotal colectomy (STC) is performed for severe acute and refractory colitis. The diagnosis can be difficult even after the surgery when colectomy specimen has overlapping features of ulcerative colitis (UC) and Crohn’s disease (CD). The aim of this study was to evaluate the rate of postoperative diagnostic revision to CD after surgery and determine predictor factors.

Methods

Retrospective study of 110 patients who underwent STC (2005–2018).

Results

Preoperative diagnosis comprised UC = 80 (73%), CD = 11 (10%), and unclassified colitis (IBDU = 19, 17%). Initial diagnosis of IBDU and UC was modified to CD in 6 patients (6%) after STC. The final diagnosis after the follow-up of 10 ± 6 years switched from CD for 8 patients (9%). The multivariate analysis showed that patients with a colitis evolving for less than 10 years and initial diagnosis of IBDU were the two independent factors associated with an increased risk of diagnosis change to CD (p = 0.03; p = 0.016). At the end of the follow-up, 15 patients (14%) had a definitive stoma.

Conclusions

In patients with IBD, attention must be paid to determine the right restorative strategy to patients with an evolution of the disease less than 10 years or with IBDU who are more at risk to have a diagnosis change to CD after STC.

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Data availability

On request to the corresponding author.

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Author information

Authors and Affiliations

  1. Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, F-75012, Paris, France

    Hélène Hermand, Jérémie H. Lefèvre, Conor Shields, Najim Chafai, Clotilde Debove & Yann Parc

  2. Mater Misericordia University Hospital, Dublin, Ireland

    Conor Shields

  3. Department of Gastroenterology, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP Hôpital Saint-Antoine, Sorbonne Université, Paris, France

    Laurent Beaugerie

  4. Department of Pathology, Assistance Publique Hôpitaux de Paris, Hôpital Saint Antoine, Sorbonne Université, Paris, France

    Magali Svrcek

Authors
  1. Hélène Hermand
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  2. Jérémie H. Lefèvre
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  6. Laurent Beaugerie
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  7. Magali Svrcek
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  8. Yann Parc
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Consortia

for the Saint-Antoine IBD Network

Contributions

Study conception: JHL, LB, YP. Data acquisition: HH, MS, NC. Analysis of data: HH, JHL, MS, NC. First draft writing: HH, JHL, CS, MS, LB, YP. Manuscript correction: all authors. Final approval: all authors.

Corresponding author

Correspondence to Jérémie H. Lefèvre.

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Conflict of interest

The authors declare that they have no conflict of interest.

Statement of ethics

No ethical approval was needed as it was a retrospective study. All patients had given a written informed consent.

Additional information

Statements

List of collaborators of the Saint Antoine IBD Network: Lionel Arrivé, Laurent Beaugerie, Anne Bourrier, Marine Camus, Najim Chafai, Edouard Chambenois, Ulriikka Chaput, Clotilde Debove, Charlotte Delattre, Xavier Dray, Jean-François Fléjou, Guillaume Le Gall, Nadia Hoyeau, Julien Kirchgesner, Cécilia Landman, Jérémie H. Lefèvre, Philippe Marteau, Chloé Martineau, Laurence Monnier-Cholley, Isabelle Nion-Larmurier, Violaine Ozenne, Yann Parc, Philippe Seksik, Harry Sokol, Magali Svrcek, Emmanuel Tiret.

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Hermand, H., Lefèvre, J.H., Shields, C. et al. Postoperative diagnostic revision for Crohn disease after subtotal colectomy for inflammatory bowel disease. Int J Colorectal Dis 36, 709–715 (2021). https://doi.org/10.1007/s00384-020-03783-9

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  • DOI: https://doi.org/10.1007/s00384-020-03783-9

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