Abstract
Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract
resulting in progressive tissue damage, which can result in strictures, fistulae,
and abscesses formation. The triggering mechanism is thought to be in the fecal stream,
and diversion of this fecal stream is sometimes required to control disease when all
other avenues of medical and surgical management have been exhausted. Fecal diversion
can be temporary or permanent with the indications being defunctioning a high-risk
anastomosis, as a result of a surgical complication, for disease control, or due to
severe colonic, rectal, or perianal disease. The incidence of ostomy formation in
CD has increased epidemiologically over time. The primary indication for ostomy formation
is severe perianal fistulizing disease. However, while 64% of patients have an early
clinical response after diversion for refractory perianal CD, restoration of bowel
continuity is attempted in only 35% of patients, and is successful in only 17%. The
current review discusses the indications for ostomy creation in complex CD, strategies
for procedure selection, and patient outcomes.
Keywords
Crohn's disease - ileostomy - colostomy - ostomy - stoma - fistula - abscess - stricture
- colitis
