Diverting ileostomy for colonic Crohn's disease part I: Significance of ulcers 5 mm in depth or deeper on the preoperative barium enema

In patients with colonic Crohn's disease who had failed to respond to medical treatment, a diverting ileostomy resulted in persistent relief of symptoms in 60% of the cases. The authors reviewed the radiographs performed prior to diverting ileostomy on 15 patients who had colonic Crohn's disease. A number of spike-like ulcers in the colon, 5 mm in depth or deeper, of various types, occurred in patients in whom surgery had failed. Ulcers 5 mm or greater in depth destroy the colonic muscularis propria and, if numerous, probably result in irreversible changes. If studies on larger numbers of patients confirm this finding, diverting ileostomy would be indicated before numerous deep ulcers develop.