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A perforating phenotype is associated with an increased postoperative morbidity in patients with Crohn's disease particularly after ileocolic resection.One hundred and ninety-seven patients underwent 231 bowel resections for perforating ileitis between 1992 and 2009. The duration or clinical deterioration was calculated from the onset of clinical exacerbation unresponsive to any medical treatment to the date of surgery.The median duration of clinical deterioration leading to surgery was 5 months. Patients with apreoperative exacerbation lasting > 5 months had a higher number of structures involved in the inflammatory mass (3.3 vs 2.8 structures, P = 0.013), and had a higherprobability of taking immunosuppressive drugs (26% vs 14%, P = 0.042), and a multiple-drug combination (31% vs 16%, P = 0.015) at the time of surgery. Patients with symptoms lasting > 5 monthsprior to surgery had a higher incidence of postoperative complications (31% vs 13%, P = 0.002). There was a significant increase in the duration ofpreoperative clinical deterioration, size of the inflammatory mass, incidence of weight loss, intake of immunosuppressants, and the postoperative morbidity during the last 5 years of the study.Delay in surgery in patientspresenting with symptoms attributable to perforating ileitis is associated with an increased postoperative risk.