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AbuDalu M, Munz Y, Ohana G. Symptomatic ileocolic pseudoaneurysm following laparoscopic ileocecectomy for Crohn's disease: A case report. Int J Surg Case Rep 2022; 94:107059. [PMID: 35413674 PMCID: PMC9018133 DOI: 10.1016/j.ijscr.2022.107059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/20/2022] [Accepted: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Crohn's disease is prevalent worldwide. It is an idiopathic, chronic and relapsing disease, characterized by chronic inflammation of any part of the gastrointestinal tract. Vascular involvement rarely occurs in Crohn's patients. However, the chronic inflammatory process leads to structural and functional changes in the vascular endothelium. We present a case of ileocolic artery pseudoaneurysm after laparoscopic ileocecectomy in a Crohn's patient. Case presentation We report a case of a 26-years-old male diagnosed with Crohn's disease 4 months prior to an elective laparoscopic ileocecectomy. Before the operation, the patient suffered from severe terminal ileitis and typhlitis with signs of micro perforation. 3 weeks following his discharge, the patient arrived at the ER complaining of severe right lower abdominal pain. Computerized Tomography (CT) scans revealed a 35 mm ileocolic pseudoaneurysm that was treated urgently with coil-embolization via angiography. Discussion Until recently, few reports regarding the involvement of pseudoaneurysm of mesenteric arteries in relation to bowel resection surgeries have been reported. It is believed that the chronic inflammatory process induces a potent effect on the vascular endothelium, leading to thick, inflamed and highly friable mesenteric vessel walls. We propose that the pseudoaneurysm occurred as a result of surgical intervention on a thickened and diseased mesentery artery branch. Conclusion Inclusion of mesenteric resection in Crohn patients' undergoing bowel resection may be an innovative way to avoid this complication and to reduce recurrence. Crohn’s disease is characterized by chronic inflammation of any part of the gastrointestinal tract. Mesenteric vascular involvement in Crohn’s’ disease. A case of ileocolic artery pseudoaneurysm after laparoscopic ileocecectomy in a Crohn’s patient. Mesenteric resection in Crohn patients’ undergoing bowel resection may be an innovative way to reduce recurrence.
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Boaron L, Facchin L, Bau M, Zacharias P, Ribeiro D, Miranda EF, Barcelos IFD, Ropelato RV, Steckert Filho Á, Meira Junior JDD, Sassaki L, Saad-Hossne R, Kotze PG. Postoperative complication rates between Crohn's disease and Colorectal cancer patients after ileocolic resections: a comparative study. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Abstract
Introduction Ileocolic resection (ICR) is the most common surgical procedure performed for Crohn's disease (CD). Similarly, right-sided Colorectal cancer (CRC) is treated by the same operation. The primary aim of this study was to analyze and compare the frequency and profile of early postoperative complications of ICR between patients with CD and CRC.
Methods Retrospective and observational study with patients submitted to ICR from two Brazilian tertiary referral units in colorectal surgery. We included patients with diagnosis of CD or CRC, treated with ICR, at any stage of follow-up. Variables analyzed: age at surgery, gender, diagnosis, surgical approach (open or laparoscopy), type of anastomosis (hand-sewn/stapled; end-to-end/side-to-side), presence and type of early postoperative complications (30 days) and mortality, among others.
Results 109 patients were included, 73 with CD (67%) and 36 with CRC (33%). CD patients were younger (42.44 ± 12.73 years vs. 66.14 ± 11.02 years in the CRC groups, p < 0.0001) and had more previous resections (20 ± 27.4 in CD and 0 in CCR, p = 0.001). There were no significant differences between the groups in terms of overall early postoperative complications [17/73 (23.3%) in the CD and 5/36 (13.9%) in the CRC groups (p = 0.250)]. There was no significant difference between the groups in relation to anastomotic leakage (p = 0.185), surgical site infections (p = 0.883), other complications (0.829) and deaths (p = 0.069).
Conclusions There was no significant difference in early postoperative complications in patients with CD or CRC submitted to ICR.
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Affiliation(s)
- Larissa Boaron
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Luiza Facchin
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Mariella Bau
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Patricia Zacharias
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Diogo Ribeiro
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Eron Fábio Miranda
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Ivan Folchini de Barcelos
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | - Renato Vismara Ropelato
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
| | | | | | - Ligia Sassaki
- Universidade Estadual Paulista (UNESP), Ambulatório de Doenças Inflamatórias Intestinais, Botucatu, SP, Brazil
| | - Rogério Saad-Hossne
- Universidade Estadual Paulista (UNESP), Ambulatório de Doenças Inflamatórias Intestinais, Botucatu, SP, Brazil
| | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná (PUCPR), Hospital Universitário Cajuru, Serviço de Coloproctologia (SeCoHUC), Curitiba, PR, Brazil
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Hossne RS, Sassaki LY, Baima JP, Meira Júnior JDD, Campos LM. ANALYSIS OF RISK FACTORS AND POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH CROHN'S DISEASE. ARQUIVOS DE GASTROENTEROLOGIA 2019; 55:252-257. [PMID: 30540087 DOI: 10.1590/s0004-2803.201800000-63] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/02/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The post-operative complications rate is greater in patients with Crohn's disease than in other abdominal surgeries due to other benign conditions. Prevention and management of such complications are important factors in the care of these patients. OBJECTIVE The objectives of this research are to analyze the rate of postoperative complications and the major risk factors in patients with Crohn's disease. METHODS A descriptive and retrospective study based on analysis of medical records of patients with Crohn's disease undergoing ileal and/or colonic resection, which analyzed the main surgical complications and their major risk factors. RESULTS Forty-four surgical procedures and thirty-seven patients were analyzed. Most were female (56.7%). Postoperative complications were observed in 18 (40.9%) surgeries. The disease duration (P=0.04), the penetrating behavior (P=0.013), the time between diagnosis and the first surgery (P=0.04), malnutrition with low body mass index (BMI), duration of surgery (P=0.016), and the size of the removed specimen (P=0.014) were associated with higher rates of complications. The use of drugs blocking tumor necrosis factor up to eight weeks before surgery was not significantly associated with higher complications rates or increased need for reoperation. CONCLUSION The complication rate observed in this study is similar to published data. The duration of the disease, the penetrating behavior, the size of the removed specimen, the duration of the surgery, and BMI are important risk factors for perioperative complications in Crohn's disease.
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Affiliation(s)
- Rogério Saad Hossne
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
| | - Ligia Yukie Sassaki
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Clínica Médica, Botucatu, SP, Brasil
| | - Julio Pinheiro Baima
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Clínica Médica, Botucatu, SP, Brasil
| | - José Donizeti de Meira Júnior
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
| | - Luana Moraes Campos
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil
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