Ileocolic anastomotic inflammation after resection for Crohn’s disease indicates disease recurrence: a histopathologic study

Abstract

Objectives: We performed a pathological pilot study to characterize the inflammation at the ileocolic anastomosis as Crohn’s disease or ischemia.

Methods and materials: Subjects were selected at random from a retrospective database of patients with Crohn’s disease and who had undergone an ileocolic resection with subsequent endoscopic assessment of the anastomosis and neo-terminal ileum. Pathology slides from the anastomotic mucosa, either from targeted biopsies or subsequent ileocolic resections, were re-assessed histologically for features of ischemia and of Crohn’s disease.

Results: Twenty-nine specimens from 8 patients were reviewed, including 12 ileocolic resection specimens and 17 sets of endoscopic biopsies. Twenty-seven of the 29 specimens, accounting for all of the patients, had evidence of CD-like features. In contrast, only 2 specimens, accounting for 2 of 8 patients, had histologic features of ischemia, and both specimens also had Crohn’s-like features.

Conclusion: To our knowledge this is the first study to specifically evaluate the pathology of ileocolic anastomoses in Crohn’s disease. It suggests that anastomotic inflammation is predominantly a manifestation of recurrent Crohn’s disease rather than of postoperative ischemia.

Keywords:

• Crohn’s disease
• post-operative
• histology
• pathology

Disclosure statement

The authors report no conflict of interest.

Author contributions

RPH, SM, NH developed the concept and design; RPH, SM, NH drafted the manuscript. RPH, SM, BLC, BES, JFC, NH critically revised the manuscript for important intellectual content.