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Chiarello MM, Pepe G, Fico V, Bianchi V, Tropeano G, Altieri G, Brisinda G. Therapeutic strategies in Crohn’s disease in an emergency surgical setting. World J Gastroenterol 2022; 28:1902-1921. [PMID: 35664965 PMCID: PMC9150057 DOI: 10.3748/wjg.v28.i18.1902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/28/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease (CD) remains a chronic, incurable disorder that presents unique challenges to the surgeon. Multiple factors must be considered to allow development of an appropriate treatment plan. Medical therapy often precedes or complements the surgical management. The indications for operative management of CD include acute and chronic disease complications and failed medical therapy. Elective surgery comes into play when patients are refractory to medical treatment if they have an obstructive phenotype. Toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage represent indications for emergency surgery. These patients are generally in critical conditions and present with intra-abdominal sepsis and a preoperative status of immunosuppression and malnutrition that exposes them to a higher risk of complications and mortality. A multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care. Moreover, the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical operations. In this review, we aimed to discuss the acute complications of CD and their treatment.
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Affiliation(s)
- Maria Michela Chiarello
- Department of Surgery, San Giovanni in Fiore Hospital, Azienda Sanitaria Provinciale di Cosenza, Cosenza 87100, Italy
| | - Gilda Pepe
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Valeria Fico
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Tropeano
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Gaia Altieri
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Brisinda
- Department of Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Medical and Surgical Science, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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2
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Myrelid P, Soop M, George BD. Surgical Planning in Penetrating Abdominal Crohn's Disease. Front Surg 2022; 9:867830. [PMID: 35592128 PMCID: PMC9110798 DOI: 10.3389/fsurg.2022.867830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Crohn's disease (CD) is increasing globally, and the disease location and behavior are changing toward more colonic as well as inflammatory behavior. Surgery was previously mainly performed due to ileal/ileocaecal location and stricturing behavior, why many anticipate the surgical load to decrease. There are, however, the same time data showing an increasing complexity among patients at the time of surgery with an increasing number of patients with the abdominal perforating disease, induced by the disease itself, at the time of surgery and thus a more complex surgery as well as the post-operative outcome. The other major cause of abdominal penetrating CD is secondary to surgical complications, e.g., anastomotic dehiscence or inadvertent enterotomies. To improve the care for patients with penetrating abdominal CD in general, and in the peri-operative phase in particular, the use of multidisciplinary team discussions is essential. In this study, we will try to give an overview of penetrating abdominal CD today and how this situation may be handled. Proper surgical planning will decrease the risk of surgically induced penetrating disease and improve the outcome when penetrating disease is already established. It is important to evaluate patients prior to surgery and optimize them with enteral nutrition (or parenteral if enteral nutrition is ineffective) and treat abdominal sepsis with drainage and antibiotics.
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Affiliation(s)
- Pär Myrelid
- Department of Surgery, Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mattias Soop
- Department of Surgery, Ersta Hospital, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Bruce D. George
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Huerta CT, Ribieras AJ, Kodia K, Yeh DD, Kerman D, Byers P. Small Intestinal Perforation Secondary to Necrotizing Enteritis-An Under-Recognized Complication of Crohn's Disease. Am Surg 2022:31348211054521. [PMID: 35023785 DOI: 10.1177/00031348211054521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Small bowel perforation is an uncommon but severe event in the natural history of Crohn's disease with fewer than 100 cases reported. We review Crohn's disease cases with necrotizing enteritis and share a case of a 26-year-old female who presented with a recurrent episode of small intestinal perforation. A PubMed literature review of case reports and series was conducted using keywords and combinations of "Crohn's disease," "small intestine perforation," "small bowel perforation," "free perforation," "regional enteritis," and "necrotizing enteritis." Data extracted included demographic data, pre- or postoperative steroid administration, medical or surgical management, and case fatality. Nineteen reports from 1935 to 2021 qualified for inclusion. There were 43 patients: 20 males and 23 females with a mean age of 36 ± 15 years old. 75 total perforations were described: 56 ileal (74.6%), 15 jejunal (20.0%), 2 cecal (2.7%), and 1 small intestine non-specified (2.7%). 38 of 43 patients were managed surgically by primary repair (11), ostomy creation (21), or an anastomosis (11). Of 11 case fatalities, medical management alone was associated with higher mortality (5/5; 100% mortality) compared to those treated surgically (6/38; 15.8% mortality; P < .001). Patient sex, disease history, acute abdomen, and pre- or postoperative steroid use did not significantly correlate with mortality. Jejunal perforation was significantly (P = .028) associated with event mortality while ileal was not (P = .45). Although uncommon, necrotizing enteritis should be considered in Crohn's patients who present with small intestinal perforation. These cases often require urgent surgical intervention and may progress to fulminant sepsis and fatality if not adequately treated.
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Affiliation(s)
| | - Antoine J Ribieras
- 275894University of Miami DeWitt Daughtry Department of Surgery, Miami, FL, USA
| | - Karishma Kodia
- 275894University of Miami DeWitt Daughtry Department of Surgery, Miami, FL, USA
| | - D Dante Yeh
- 275894University of Miami DeWitt Daughtry Department of Surgery, Miami, FL, USA
| | - David Kerman
- University of Miami Department of Gastroenterology, Miami, FL, USA
| | - Patricia Byers
- 275894University of Miami DeWitt Daughtry Department of Surgery, Miami, FL, USA
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4
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Jeong SH, Choi JS, Kim JW, Kim HM, Kim HS, Im JP, Kim JS, Kim YS, Cheon JH, Kim WH, Ye BD, Kim YH, Han DS. Clinical Features of Intra-Abdominal Abscess and Intestinal Free-Wall Perforation in Korean Patients with Crohn's Disease: Results from the CONNECT Study. J Clin Med 2020; 10:jcm10010116. [PMID: 33396251 PMCID: PMC7794699 DOI: 10.3390/jcm10010116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 01/04/2023] Open
Abstract
Background: In Crohn's disease (CD), intra-abdominal abscess (IA) and intestinal free-wall perforation (IP) have a common mechanism of transmural inflammation; however, their manifestation is different. Objective: This study aimed to investigate differences in the clinical features between IA and IP in Korean patients with Crohn's disease. Design: A retrospective cohort study. Setting: Thirty university hospitals and two local hospitals in Korea. Patients: Patients who were diagnosed with CD between July 1982 and December 2008 were enrolled. Main Outcome Measures: Clinical characteristics of IA and IP. Results: Among 1286 patients with CD, 147 (11.4%) had IA and 83 (6.5%) had IP. IA patients were younger than those of IP (24.2 ± 8.6 vs. 30.4 ± 11.1 years, p = 0.001). Location and behavior were significantly different between IA and IP (p = 0.035 and 0.021). In multivariate analyses, perianal fistula was not associated with increased risk of IA and IP, while intestinal stricture was associated with increased risk of IA (OR: 2.72, p < 0.0001) and IP (OR: 2.76, p < 0.0001). In subgroup analyses, 55 (36.5%) IA patients were diagnosed at the diagnosis of CD, and 92 (63.5%) during follow-up of CD, while 47 (56.6%) IP patients were diagnosed at the diagnosis of CD, and 36 (43.3%) during follow-up of CD. Conclusions: There are several differences in the clinical features of IA and IP in Korean patients with CD. The development mechanism is considered as identical, but further investigation should be needed for clinical implication.
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Affiliation(s)
- Seok-Hoo Jeong
- Department of Internal Medicine, Catholic Kwandong University International St. Mary’s Hospital, Incheon 22711, Korea; (S.-H.J.); (J.S.C.)
| | - Ja Sung Choi
- Department of Internal Medicine, Catholic Kwandong University International St. Mary’s Hospital, Incheon 22711, Korea; (S.-H.J.); (J.S.C.)
| | - Jin Woo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26526, Korea; (J.W.K.); (H.-S.K.)
| | - Hee Man Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26526, Korea; (J.W.K.); (H.-S.K.)
- Correspondence:
| | - Hyun-Soo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26526, Korea; (J.W.K.); (H.-S.K.)
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea; (J.P.I.); (J.S.K.)
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea; (J.P.I.); (J.S.K.)
| | - You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul 04551, Korea;
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.C.); (W.H.K.)
| | - Won Ho Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.C.); (W.H.K.)
| | - Byong Duk Ye
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea;
| | - Young-Ho Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 03181, Korea;
| | - Dong Soo Han
- Department of Internal Medicine, Hanyang University College of Medicine, Guri 11923, Korea;
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Kolar M, Pilkington M, Winthrop A, MacDonald H, Justinich C, Soboleski D, Sly L, Hurlbut D. Free intestinal perforation in children with Crohn's disease. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Incidence of and Risk Factors for Free Bowel Perforation in Patients with Crohn's Disease. Dig Dis Sci 2017; 62:1607-1614. [PMID: 28315037 DOI: 10.1007/s10620-017-4539-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 03/10/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Incidence of and risk factors for intestinal free perforation (FP) in patients with Crohn's disease (CD) are not established. AIM To establish rate of and risk factors for FP in a large cohort of CD patients. METHODS Medical records of CD patients who visited Asan Medical Center from June 1989 to December 2012 were reviewed. After matching the FP patients to controls (1:4) by gender, year, and age at CD diagnosis, and disease location, their clinical characteristics were compared using conditional logistic regression analysis. RESULTS Among 2043 patients who were included in our study cohort, 44 patients (2.15%) developed FP over a median follow-up period of 79.8 months (interquartile range 37.3-124.6), with an incidence of 3.18 per 1000 person-years [95% confidence interval (CI) 2.37-4.28]. All 44 patients underwent emergency surgery, and eight patients underwent reoperation within 12 months (8/44, 18.2%). Multivariable-adjusted analysis revealed that anti-TNF therapy [odds ratio (OR), 3.73; 95% CI 1.19-11.69; p = 0.024] was associated with an increased risk of FP. CONCLUSIONS The incidence of FP in a large cohort of Korean CD patients was 2.15%, which was similar to that in Western reports. Anti-TNF therapy could be risk factors for FP.
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Birindelli A, Tugnoli G, Beghelli D, Siciliani A, Biscardi A, Bertarelli C, Selleri S, Lombardi R, Di Saverio S. Emergency laparoscopic ileo-colic resection and primary intracorporeal anastomosis for Crohn's acute ileitis with free perforation and faecal peritonitis: first ever reported laparoscopic treatment. SPRINGERPLUS 2016; 5:16. [PMID: 26759755 PMCID: PMC4703595 DOI: 10.1186/s40064-015-1619-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/14/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Laparoscopy for abdominal surgical emergencies is gaining increasing acceptance given the spreading of advanced laparoscopic skills among modern surgeons, as it may allow at the same time an accurate diagnosis and appropriate treatment of acute abdomen. The use of the laparoscopic approach also in case of diffuse peritonitis is now becoming accepted provided hemodynamic stability, despite the common belief in the past decades that such severe condition represented an indication for conversion to open surgery or an immediate contraindication to continue laparoscopy. Crohn's Disease (CD) is a rare cause of acute abdomen and peritonitis, only a few cases of CD acute perforations are reported in the published literature; these cases have always been approached and treated by open laparotomy. CASE DESCRIPTION We report on a case of a faecal peritonitis due to an acute perforation caused by a terminal ileitis in an undiagnosed CD. The patient underwent diagnostic laparoscopy followed by a laparoscopic ileo-colic resection and primary intracorporeal anastomosis, with a successful postoperative outcome. CONCLUSIONS Complicated CD has to be considered within the possible causes of small bowel non-traumatic perforation. Emergency laparoscopy with resection and primary intra-corporeal anastomosis can be feasible and may be a safe and effective minimally invasive alternative to open surgery even in case of faecal peritonitis, in selected stable patients and in presence of appropriate laparoscopic colorectal surgical skills and experience. To the best of our knowledge the present experience is the first ever reported case managed with a totally laparoscopic extended ileocecal resection with intracorporeal anastomosis in case of acutely perforated CD and diffuse peritonitis.
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Affiliation(s)
- A. Birindelli
- />Maggiore Hospital Regional Emergency Surgery and Trauma Center–Bologna Local Health District, Bologna, Italy
| | - G. Tugnoli
- />Maggiore Hospital Regional Emergency Surgery and Trauma Center–Bologna Local Health District, Bologna, Italy
| | - D. Beghelli
- />Maggiore Hospital Regional Emergency Surgery and Trauma Center–Bologna Local Health District, Bologna, Italy
| | - A. Siciliani
- />Maggiore Hospital Regional Emergency Surgery and Trauma Center–Bologna Local Health District, Bologna, Italy
| | - A. Biscardi
- />Maggiore Hospital Regional Emergency Surgery and Trauma Center–Bologna Local Health District, Bologna, Italy
| | - C. Bertarelli
- />Maggiore Hospital Pathology Department–Bologna Local Health District, Bologna, Italy
| | - S. Selleri
- />Maggiore Hospital Regional Emergency Surgery and Trauma Center–Bologna Local Health District, Bologna, Italy
| | - R. Lombardi
- />Maggiore Hospital Regional Emergency Surgery and Trauma Center–Bologna Local Health District, Bologna, Italy
| | - S. Di Saverio
- />Maggiore Hospital Regional Emergency Surgery and Trauma Center–Bologna Local Health District, Bologna, Italy
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9
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Doh YS, Kim YS, Bae SI, Im JP, Cheon JH, Ye BD, Kim JW, Park YS, Lee JH, Kim YH, Kim JS, Han DS, Kim WH. The clinical characteristics of patients with free perforation in Korean Crohn's disease: results from the CONNECT study. BMC Gastroenterol 2015; 15:31. [PMID: 25887913 PMCID: PMC4373039 DOI: 10.1186/s12876-015-0262-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/04/2015] [Indexed: 12/18/2022] Open
Abstract
Background Free perforation is the most severe and debilitating complication associated with Crohn’s disease (CD), and it usually requires emergency surgery. The aim of this study was to evaluate the incidence of free perforation among Korean patients with CD. Methods The CrOhn's disease cliNical NEtwork and CohorT (CONNECT) study was conducted nationwide in Korea, and patients who were diagnosed with CD between 1982 and 2008 were included in this retrospective study. We investigated the incidence of free perforation among these patients and their clinical characteristics. Results A total of 1346 patients were analyzed and 88 patients (6.5%) were identified with free perforation in CD. The mean age of the free perforation group was 31.8 ± 13.0 years, which was significantly higher than that of the non-perforated group (27.5 ± 12.1 years) (p = 0.004). Free perforation was the presenting sign of CD in 46 patients (52%). Of the 94 perforations that were present in 88 patients, 81 involved the ileum. Multivariate logistic regression analysis determined that free perforation was significantly associated with being aged ≥ 30 years at diagnosis (OR 2.082, p = 0.002) and bowel strictures (OR 1.982, p = 0.004). The mortality rate in the free perforation group was significantly higher (4.5%) than that in the non-perforated group (0.6%) (p < 0.001). Conclusion The incidence of free perforation in Korean patients with CD was 6.5%. Being aged ≥ 30 years at CD diagnosis and bowel strictures were significant risk factors associated with free perforation.
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Affiliation(s)
- Young Seok Doh
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, 85 Geo-dong 2 ga, Jung-gu, Seoul, 100-032, South Korea.
| | - You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, 85 Geo-dong 2 ga, Jung-gu, Seoul, 100-032, South Korea.
| | - Song I Bae
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, 85 Geo-dong 2 ga, Jung-gu, Seoul, 100-032, South Korea.
| | - Jong Pil Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
| | - Byong Duk Ye
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Ji Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Young Sook Park
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, South Korea.
| | - Ji Hyun Lee
- Department of Internal Medicine, Seoul Song Do Colorectal Hospital, Seoul, South Korea.
| | - Young-Ho Kim
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Joo Sung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Dong Soo Han
- Department of Internal Medicine, Hanyang University College of Medicine, Guri, South Korea.
| | - Won Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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MIYAJIMA NOBUYOSHI, YAMAKAWA TATSUO. Laparoscopic treatment of colonic stenosis due to perforation in crohn’s disease. Dig Endosc 2002. [DOI: 10.1046/j.1443-1661.2002.00156.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- NOBUYOSHI MIYAJIMA
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan
| | - TATSUO YAMAKAWA
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan
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Abstract
Small intestinal perforation is an infrequent but often fatal complication of a variety of disorders. Treatment of 76 adults with nontraumatic perforation occurring during a 21 year period was reviewed. The majority of perforations were due to mechanical causes, malignancy, and Crohn's disease. An abdominal mass (53 percent, p less than 0.05) and fever (81 percent, p less than 0.01) were most frequently documented in patients with Crohn's disease, whereas a positive result on fecal occult blood testing (77 percent, p less than 0.025) was common in those with malignant perforations. Otherwise, clinical and laboratory manifestations, including radiographic evidence of free air, were inconstant. The overall mortality rate was 29 percent, with 65 (86 percent) of the patients undergoing operation. Survival was independent of diagnostic delay (p greater than 0.10). In general, despite various causes and delays in diagnosis, resection and primary anastomosis remains an effective treatment for perforation of the small bowel.
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Brower RA. Jejunal perforation possibly induced by slow-release potassium in a patient with Crohn's disease. Dig Dis Sci 1986; 31:1387-90. [PMID: 3803140 DOI: 10.1007/bf01299819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A case of small bowel ulceration and perforation possibly due to therapy with Klotrix in a patient with Crohn's disease is presented. Following emergent surgery with creation of a diverting loop jejunostomy, subsequent reestablishment of intestinal continuity was carried out with excellent clinical results. Gastrointestinal mucosal lesions possibly due to wax-matrix potassium chloride preparations are reviewed.
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Bundred NJ, Dixon JM, Lumsden AB, Gilmour HM, Davies GC. Free perforation in Crohn's colitis. A ten-year review. Dis Colon Rectum 1985; 28:35-7. [PMID: 3971798 DOI: 10.1007/bf02553904] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A review of 198 patients with Crohn's disease of the colon who presented over a ten-year period identified six patients with free perforation of the colon (3 percent). Five were females and all were known to have pre-existing Crohn's disease. Four were taking oral corticosteroids at the time of perforation. The sole male presented with acute toxic dilatation of the colon and had not received previous steroids. Pneumoperitoneum was seen in five of the six patients. Subtotal colectomy with ileostomy appears to be the optimum treatment in patients presenting with this complication of Crohn's disease.
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Abstract
During a five-year period, three patients with general peritonitis, secondary to perforation of the small bowel in Crohn's disease, were successfully treated by resection and primary anastomosis. During this period, 30 patients presented with small bowel or ileocaecal Crohn's disease. The possibility of perforation should be considered when evaluating the need for surgery in patients with Crohn's disease with symptoms of obstruction.
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