Ileal Conduit Formation in Patients with Crohn’s Disease Undergoing Pelvic Exenteration

Background/Objectives: Crohn’s disease (CD) is traditionally considered a relative contraindication to ileal conduit (IC) urinary diversion, yet published evidence remains limited. This study evaluated urological complication rates and short-term outcomes of CD patients undergoing IC formation during pelvic exenteration (PE) for advanced pelvic malignancy and benign fistulae. Methods: An institutional prospective PE database (2008–2024) was analysed comparing patients with or without CD. The primary endpoint included urological complications (ureteroileal anastomotic leak and stricture, conduit leak, and stenosis) and need for re-intervention (nephrostomy, antegrade stents, revision surgery). Statistical analysis included Fisher-exact and Mann–Whitney-U tests (p ≤ 0.05), with multivariate regression controlling for age, disease factors, and operative complexity. Results: Among 441 patients who underwent IC formation, 12 had CD. The CD cohort was younger and more commonly had recurrent rectal cancers (67.0% vs. 34.0%; p = 0.02), requiring more complex resections including sacrectomy (83.0% vs. 52.0%; p = 0.04) and experiencing greater blood loss (5000 vs. 2400 mL; p = 0.04). CD patients had higher overall urological complication rates (41.7% vs. 13.3%; p = 0.017) and re-intervention was more frequent, including percutaneous nephrostomy (41.7% vs. 11.2%; p = 0.009) and revision surgery (25.0% vs. 4.7%; p = 0.02). On multivariate analysis, CD remained independently associated with need for re-intervention (odds ratio [OR] = 4.48, 95% confidence interval [CI] = 1.35–14.89; p = 0.014). Conclusions: CD does not appear to preclude IC formation in PE surgery. Despite potentially higher urological complication risk in a complex surgical cohort, the results of this study highlight its feasibility in selected patients managed in a high-volume centre.