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Defunctioning Stoma Crohn — RACP Adult Medicine MCQ

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HardGastroenterologyDefunctioning Stoma CrohnRACP Adult Medicine

A 45-year-old woman with severe refractory perianal Crohn disease has failed infliximab, adalimumab, vedolizumab, and ustekinumab. She has a complex fistula with ongoing sepsis despite multiple EUAs and setons. Her quality of life is severely impaired. She has active rectal Crohn disease with proctitis. What is the most appropriate surgical consideration?

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Correct answer: D — Defunctioning stoma immediately

Refractory perianal Crohn disease with ongoing sepsis despite maximal medical therapy and multiple surgical procedures with active proctitis — defunctioning ileostomy (faecal diversion) allows the perineum to heal by diverting the faecal stream. Unfortunately, ~50-70% of patients with a defunctioning stoma for Crohn perianal disease never have their stoma reversed (perineal disease recurs with restoration of continuity). Proctectomy (removal of rectum) is the definitive last resort for severe refractory perianal/rectal Crohn.

Reference: GESA – 2024 – Refractory Perianal Crohn; ECCO 2024