Isolated Ulceration of Crohn's Anastomosis

Abstract

Background: Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract in which surgical intervention is often required in the setting of complications. After surgery, up to 90% of patients develop recurrence at 12 months. Some patients develop anemia and isolated ulceration of anastomosis with no evidence of recurrence in any segment or anastomosis itself. Aim: To define a new syndrome in patients with Crohn's disease who develop isolated anastomosis ulceration during postoperative period after ileocolonic resection. Methods: This was a retrospective analysis of adult individuals with Crohn's disease followed in the University Hospital Center of São João, Portugal. Four-hundred and eight patients with Crohn's disease related surgery were included. Evaluated criteria comprised anemia, evidence of ulceration of the anastomosis in colonoscopy, computed tomography, and/or videocapsule and need of intravenous iron. The primary outcome was ulceration of ileocolic anastomosis in these patients. Results: Sixty-nine patients (17%) presented ulceration of anastomosis. Among these, 58% had anemia at least once. In this group, 48% received intravenous iron. All patients presenting ulceration of anastomosis performed colonoscopies, 17.4% videocapsule, and 33.3% had computed tomography scan with no evidence of activity. Only six patients presented anemia and performed a colonoscopy, computed tomography, and videocapsule to investigate disease activity. Conclusions: Ulcers found in ileocolonic anastomosis are a new identity and may be related to ischemic signs. A multicentric approach is needed to classify this new syndrome, as it was only possible to perform an exploratory analysis with the available data.