Length and type of recurrent ileitis after ileal resection correlate with presurgical features in Crohn's disease

Crohn's disease of the terminal ileum usually recurs after an ileocolonic resection. To compare the length and the disease behavior of recurrent ileitis with the presurgical disease characteristics, we studied 31 consecutive patients who had recurrent Crohn's disease symptoms and who had undergone an ileocecal resection at our institution and had both pre-and postoperative radiographic small-bowel studies available for comparison. The preoperative studies were classified as primarily fibrostenotic, perforating, or inflammatory and were correlated with the findings at the time of clinical recurrence. The majority of the patients with initial fibrostenotic disease and all patients with inflammatory disease had recurrence with the same disease pattern. Perforating disease represented clinically with any of the three disease types. There was a trend toward a longer time to clinical recurrence in the perforating group. The correlation between pre- and postsurgical extent of ileal disease was high (r = 0.70, p < 0.0001). These data confirm a consistency in disease behavior and length of post-operative recurrence in Crohn's disease. The extent of presurgical disease in particular seems to be a valuable prognostic factor when contemplating surgical resection. Perforating disease does not seem to be a more aggressive disease type in terms of postoperative recurrence.