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Abstract
Postoperative recurrence of Crohn's disease may be triggered by agents in the fecal
stream. The aim of this study was to examine intestinal mucosal inflammation induced
by contact with intestinal fluids in surgically excluded ileum.
The effects of infusion of intestinal luminal contents into excluded ileum in 3 patients
with Crohn's disease who had undergone a curative ileocolonic resection with ileocolonic
anastomosis and temporary protective proximal loop ileostomy were studied by histopathology
and electron microscopy.
Contact with intestinal fluids for 8 days induced focal infiltration of mononuclear
cells, eosinophils, and polymorphonuclear cells in the lamina propria, small vessels,
and epithelium in the excluded neoterminal ileum that was previously normal. Epithelial
HLA-DR expression increased, and mononuclear cells expressed the KP-1 antigen associated
with activation. Marked up-regulation of RFD-7, RFD-9, intercellular adhesion molecule
1, and lymphocyte function-associated antigen 1 was observed after infusion, reflecting
epithelioid transformation and transendothelial lymphocyte recruitment. At the ultrastructural
level, dilatation of the endoplasmic reticulum and Golgi apparatus occurred in epithelial
cells, where also basally located transport vesicles were identified.
Intestinal contents trigger postoperative recurrence of Crohn's disease in the terminal
ileum proximal to the ileocolonic anastomosis in the first days after surgery.