Surgery is frequently performed in patients with Crohn's disease (CD), with a risk of short bowel syndrome.   The aim of our study is to evaluate  the correlation between the Rutgeerts score and clinical and endoscopic recurrence during the first year following intestinal resection surgery in patients with CD.

We conducted a retrospective analytical and descriptive study within the Hepatology, Gastroenterology, and Proctology Department of Medicine B, which collected data on all patients with Crohn's disease who underwent ileocecal or right ileocolonic resection between January 2019 and November 2025. Patients who did not undergo postoperative colonoscopy were excluded. Postoperative endoscopic recurrence was defined as a Rutgeerts score ≥ i2.

A total of 92 patients were included. The mean age was 41.3 years (20–70 years). There was a female predominance, with a female-to-male ratio of 1.19 (50 women and 42 men). The mean interval between the diagnosis of Crohn’s disease and surgery was 2.6 years.Crohn’s disease was ileocecal in 50% of cases (n = 59), ileocolic in 44.5% (n = 41), isolated ileal in 4.3% (n = 4), and extensive in 1% of patients. The disease phenotype was stenosing in 64.1% (n = 59), fistulizing in 18.4% (n = 17), combined stenosing and fistulizing in 14.1% (n = 13), and inflammatory in 2 patients.

Thirty-three patients (35.8%) had ano-perineal manifestations, including complex fistulas in 29 patients (31.5%), anal ulcerations in 2 patients (2.1%), anal stenosis in 1 patient (1%), and an anal fissure in 1 patient (1%).The surgical indications were ileal or ileocecal stenosis in 73.9% of cases (n = 59), internal or external fistulas in 20.6% (n = 19), and deep abscesses in 2 patients.

Postoperative colonoscopy was performed after a mean interval of 9.2 months (6–11 months) following surgery. Endoscopic recurrence (Rutgeerts score ≥ i2) was observed in 59.7% of patients (n = 55), including Rutgeerts i2 in 20 patients (21.7%), i3 in 9 patients (9.7%), and i4 in 26 patients (28.2%). Clinical recurrence occurred in 53.2% of patients (n = 49).

On univariate logistic regression analysis, statistically significant predictors of clinical recurrence were a Rutgeerts score ≥ i2 (p < 0.001) and the presence of LAP (p = 0.042). On multivariate analysis, only a Rutgeerts score ≥ i2 remained statistically significant (p < 0.001)

Endoscopic recurrence (ER) of Crohn’s disease, assessed using the Rutgeerts score, is strongly correlated with the risk of clinical recurrence.