Damage control surgery (DCS) has been widely used in the management of surgical patients. Crohn disease (CD) patients requiring surgery are usually severe and associated with high surgical risk, while the concept of DCS has not gained adequate attention in surgery for CD. Surgery is indicated in patients with CD to control symptoms, therefore major surgery should not be performed when the general health of the patients is not satisfactory. Use of DCS to guide surgery can reduce risk of treatment and improve clinical outcome The review is to discuss the necessity, objective, and methods of damage control surgery in the surgical treatment of Crohn disease.
Crohn Disease ; surgery ; Humans

Crohn Disease ; epidemiology ; surgery ; Humans

The inflammatory bowel diseases (IBDs), consisting of ulcerative colitis (UC) and Crohn's disease (CD), are characterized by idiopathic, chronic inflammation of the gastrointestinal tract. The overall incidence of IBDs is constantly increasing in eastern countries. In comparison with the data from western nations, in China, the incidence of male IBDs is relatively higher, the onset age is older. The severity of most cases is mild to moderate. The occurrence of fistula and peri-anal involvement are rare. Although significant improvements of IBDs therapy have been achieved in recent years, there are still over 30% UC and 70% CD cases need at least one surgery throughout their life span. Here we review the literatures published in recent years about the surgical management of IBDs.
Colitis, Ulcerative ; surgery ; Crohn Disease ; surgery ; Humans ; Inflammatory Bowel Diseases ; surgery

OBJECTIVETo investigate the diagnosis and treatment of patients with Crohn disease (CD) complicated with gastrointestinal fistulae.

METHODSClinical data of sixty-two cases with CD complicated with gastrointestinal fistula e from 1978 to 2004 were analyzed.

RESULTSThese were 68 external fistulae in 6 2 patients including recurrent fistulae in 6 cases, internal fistulae in 8 cases . Twenty- seven fistulae were located in the terminal ileum and 21 fistulae wer e located in ileocolic anastomosis site. The main surgery included 14 ileocecal resections with primary anastomosis and 26 resections of original ileocolic anastomosis with fistula and re-anastomosis. The incidence of recurrence was lower (15.4% ) in patients with postoperative medication including sulfasalazine and immunomodulator than that (34.8% ) in patients without postoperative immunomodulator,but the recurrence time was longer [(40+/- 17) months] in patients with postoperative medication than that [(8+/- 3)months] in the patients without postoperative specific medication.

CONCLUSIONSMost CD fistulae are external fistulae,most of the external fistulae are treated by resection of the fistula and anastomosis. Specific medication including sulfasalazine,mesalamine and immunomodulators should be used to prevent postoperative complications and CD recurrence.

Adult ; Crohn Disease ; complications ; diagnosis ; surgery ; Female ; Humans ; Intestinal Fistula ; complications ; diagnosis ; surgery ; Male ; Middle Aged

Inflammatory myofibroblastoma (IMT) is a rare solid tumor, and its etiology and pathogenesis are unclear. Crohn's disease is a non-specific intestinal inflammatory disease. The clinical manifestations, laboratory examinations, and imaging examinations of IMT are not specific, making diagnosis difficult. A case of Crohn's disease combined with IMT of abdominal wall was admitted to the Department of Gastroenterology at the Third Xiangya Hospital, Central South University, on Nov. 21, 2017. This patient was admitted to our hospital because of repeated right lower abdominal pain for 4 years. A 6 cm×5 cm mass was palpated in the right lower abdomen. After completing the transanal double-balloon enteroscopy and computed tomographic enterography for the small intestinal, the cause was still unidentified. The patient underwent surgery due to an abdominal wall mass with intestinal fistula on Sept. 12, 2018 and recovered well currently. According to histopathology and immunohistochemistry, he was diagnosed with Crohn's disease combined with IMT. Up to July 2020, the patients still took azathioprine regularly, without abdominal pain, abdominal distension, and other discomfort, and the quality of his life was good.
Abdominal Pain ; Abdominal Wall/surgery* ; Crohn Disease/complications* ; Humans ; Intestine, Small ; Male ; Neoplasms, Muscle Tissue/surgery*

Crohn's disease can neither be cured by surgery nor by medical therapy. Surgical therapy of recurrent Crohn's disease requires special precautions. The recurrence rate is 60% after 15 years. There are no certain data of the risk factors influencing the recurrence rate. The only clear facts are that wide resection out of the resection margins and smoking negatively influence recurrence. Hence, the major principles of therapy is a minimally-resected surgery. This mainly concerns strictures and stenosis. Strictures should be treated by stricturoplasty and stenosis by limited resection with Crohn-free resection margins. Just in case of interenteric and enterocutanous with a concomitant short bowel syndrome, in blind-ending fistulas with an abscess or in enterovesical fistulas, we recommend immediate operation. The therapy of recurrent anorectal Crohn's disease underlies the same rules as primary therapy. If necessary, proctectomy remains the last option. Also, emergency surgery in recurrent Crohn's disease follows the same rules as in elective surgery.
Crohn Disease/surgery* ; Human ; Medical Illustration ; Recurrence ; Surgical Procedures, Operative/trends*

OBJECTIVETo evaluate the diagnostic value of Crohn disease activity indices (CDAI) in assessing symptomatic recurrence following ileocolic resection for Crohn disease.

METHODSA total of 85 patients who underwent ileocolic resection between March 2003 and March 2010 were included. Clinical and endoscopic evaluation were performed within 12 months after operation. Endoscopic appearance was assessed using Rutgeers score and endoscopic recurrence was defined as endoscopic score ≥i2. Symptomatic recurrence was defined by the composite of symptom severity warranting medical therapy and endoscopic recurrence. The receiver operator characteristic (ROC) curve was used to explore the utility of CDAI in determining the presence or absence of symptomatic disease.

RESULTSNineteen patients had symptomatic recurrence within 12 months postoperatively. The mean CDAI of patients with symptomatic recurrence was 205±93, significantly higher than those with sustained remission(97±44, P<0.01). The area under the ROC curve for symptomatic recurrence and CDAI was 0.786. Symptomatic recurrence was best predicted by a CDAI cutoff of 150 and the sensitivity, specificity, and accuracy was 73.7%, 81.8% and 80.0% respectively. When a combined endoscopic and CDAI was applied, the specificity and accuracy was markedly improved to 95.5% and 90.6%. In comparison to CDAI alone, the combined use of CDAI and endoscopic evaluation had a higher level of agreement on symptomatic recurrence(Kappa value, 0.718 vs. 0.462).

CONCLUSIONSCDAI is effective to predict symptomatic recurrence. A combination of CDAI and endoscopic evaluation can further improve the accuracy of assessing symptomatic recurrence.

Anastomosis, Surgical ; Colectomy ; Crohn Disease ; diagnosis ; surgery ; Endoscopy ; Humans ; Postoperative Period ; ROC Curve ; Recurrence ; Sensitivity and Specificity

OBJECTIVETo determine whether the perioperative disease activity is associated with recurrence and complications after bowel resection for Crohn's disease (CD).

METHODSClinical data of patients underwent bowel resection for CD at the Nanjing General Hospital of Nanjing Military Command from January 2002 to January 2011 was retrospectively analyzed. Postoperative recurrence and complications in patients with active disease were compared with those in patients with remission.

RESULTSA total of 90 patients underwent bowel resection for CD, active disease were seen in 43 patients at the time of surgery, while the rest 47 patients were in remission. The postoperative cumulative endoscopic recurrence rate was 8.5% at 1 year, 27.7% at 2 years and 44.7% at 3 years in the patients with remission, and was 27.9% at 1 year, 37.2% at 2 years and 53.5% at 3 years in patients with active disease. Data indicated the endoscopic recurrence were statistically significant in the first year after surgery (χ² = 4.605, P = 0.032). Additional, the postoperative complication rates in patients with remission (14.9%) was significantly lower than that in patients with active disease (51.2%) (χ² = 6.979, P < 0.001).

CONCLUSIONPatients with active disease at the time of surgery were encountered with early postoperative recurrence and increased complications after intestinal resection for CD.

Adult ; Colon ; surgery ; Crohn Disease ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Young Adult

No abstract availble.
Abdominal Abscess/diagnosis/*surgery ; Crohn Disease/etiology/surgery/*therapy ; Humans ; Length of Stay ; Predictive Value of Tests ; Recurrence ; Severity of Illness Index

OBJECTIVETo investigate the clinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn's disease (CD).

METHODSClinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively.

RESULTSAll the cases were less than 50 years old and the most were females (8/9). Arterial occlusions occurred in either active (5/9) or inactive (4/9) stage of CD. Besides the arteries of lower extremities, other arteries could also be involved such as aorta, iliac artery, renal artery or mesentery artery. Seven cases had atherosclerotic imaging findings (4 had aortic plaques and 6 had iliac artery stenoses). Embolectomy or thromboendarterectomy were mostly performed. Four (44.4%) cases had recurrent lower limb ischemia.

CONCLUSIONSArterial occlusive disease is a rare extraintestinal manifestation of CD. A thorough inspection of aorta is necessary. Embolectomy is mostly preferred. Anticoagulation treatment is highly recommended after the operation.

Adult ; Arterial Occlusive Diseases ; etiology ; surgery ; Atherosclerosis ; etiology ; surgery ; Crohn Disease ; complications ; Embolectomy ; Female ; Humans ; Leg ; Male ; Thrombectomy ; Young Adult