Split ileostomy in the treatment of Crohn's disease of the colon

Abstract

Because of the problems associated with surgical resection of Crohn's disease of the colon a more conservative approach has been used in Oxford since 1960. The inflamed large bowel has been defunctioned by an external diversionary ileostomy and subsequently the disease has been treated with topical and oral corticosteroids. The technique of the split ileostomy used for this purpose is described and the indications for the operation and early results of its use in 69 patients are recorded. In carefully chosen cases the method has two advantages over primary resection. In some patients the inflammation improved sufficiently for continuity of the bowel to be restored without resection being necessary and without medical treatment being required. In others the ileostomy resulted in a marked improvement in general health which has made the subsequent major resection a safer procedure. As an extension of the technique the use of an external faecal diversion by ileostomy is recorded in a further 11 patients who had a synchronous resection of a segment of bowel affected by Crohn's disease.