Pathologic features of Crohn's disease associated with recrudescence after resection.

The pathologic features of Crohn's disease which influence recrudescence after resection are not known precisely. The controversy regarding the relationship between recrudescence and histopathologic evidence of Crohn's disease in resection margins is of immediate interest to pathologists because of the surgical practice of requesting frozen section examination of margins. In our studies and those of others, histopathologic findings in margins were unrelated to outcome of the patient. Thus, it is our opinion that such frozen sections should not be done. We have also found that margin length from the transected ends of a specimen to areas of evident Crohn's disease were unrelated to outcome. We therefore recommend conservative resection to obtain grossly normal margins; such a strategy will prevent unnecessary sacrifice of functional bowel in an attempt to avoid recrudescence by "radical" resection. Documentation of the pathologic findings in a resection specimen, particularly the length of bowel with and site of active Crohn's disease, may prove to be important in relation to recrudescence. The influence of histopathologic features such as granulomas on recrudescence after resection is as yet uncertain.