Recurrent Ulceration and Disease at the Ileocolonic Anastomosis in Crohn’s Disease: Etiology, Prevention, and Management, a Review Article

Ulceration at the neo-terminal ileum in patients with Crohn’s disease who have undergone previous resection remains a clinical challenge. While most patients will develop ulceration, it can be difficult to determine whether the ulceration represents a true Crohn’s recurrence. Scoring systems such as the Rutgeerts Score and modified Rutgeerts score can help differentiate between disease that may have higher risk for progression. Risk factors such as tobacco use, penetrating phenotype, and prior surgical resection have been identified, in addition to surgical technique. Recent evidence has supported certain surgical techniques, such as a side-to-side stapled technique and the Kono-S, to prevent post-surgical ulceration. Post-surgical prophylactic treatment with biologic therapies have the potential to reduce disease recurrence in certain patients. Post-surgical ulceration at the ileocolonic anastomosis is a complex problem that requires careful surveillance and evidence-based management. Understanding which patients are at high risk for disease recurrence and progression is important to guide treatment.