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Query: UMLS:C0010346 (Crohn's disease)
 21,615 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnosis of Crohn's disease in 13 patients (ten females and three males) at the Howard University Hospital during the ten-year period, 1965-1975, is examined. The most common presenting symptoms were right lower quadrant (RLQ) pain, diarrhea, anorexia, weight loss, and vomiting, while the most common physical finding was RLQ tenderness. Ileocolic involvement occurred most frequently. Eight patients had surgical resection. The most frequent operation was ileocolic resection with ileo-ascending colostomy. The chief indications for surgery were: (1) presumed appendicitis, (2) intestinal obstruction, and (3) internal fistulae.Crohn's disease seems to occur in blacks much less frequently than in whites. When compared to series of white patients reported by others, the series studied here has more females and more ileocolic involvement. In most other series, the greatest involvement is in the "ileum only" group.
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PMID:Crohn's disease in black patients. 85 35

Between 1965 and 1975, 27 patients underwent surgical treatment for ileosigmoidal fistulas complicating Crohn's disease at the Cleveland Clinic. There was no death and no anastomotic leak. The preferred procedure is resection of the ileocecal area involved by Crohn's disease with ileocolic anastomosis and a separate segmental resection of the sigmoid colon with colocolic anastomosis. A covering temporary loop ileostomy is used when there is associated pelvic sepsis or small-bowel obstruction.
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PMID:The dilemma of Crohn's disease: ileosigmoidal fistula complicating Crohn's disease. 87 7

Comparable histologic alterations of intramural nervous tissue were reported in various diseases of the small and large intestine. In 6 cases, an intestinal obstruction was present which led to secondary intramural inflammation. The obstruction was induced by the spastic segment in Hirschsprung's disease (3 cases), by rectal atresia (2 cases) and by postoperative ischemic damage to the intestinal wall (1 case). In 4 other patients, the inflammation was predominant. The diseases considered were necrotizing enterocolitis (1 case), membranous enteritis (1 case) and Crohn's disease (2 cases). On the one hand, inflammatory infiltration composed primarily of lymphocytes was observed histologically in various degrees proximal to the obstruction in all cases. On the other, comparable alterations were found in splittering of nerve fibers and deterioration of nerve cells (degenerative alterations) in the plexus myentericus as well as hyperplasia and hyperchromasia of ganglion cells. Schwann cell proliferation and fibrosis in nerve fibers (reactive alterations). Until now such alterations were only observed in Chagas' disease and in ulcerative colitis, especially complicated by toxic megacolon. It is suspected that the neurodegenerative alterations in these diseases are toxically induced.
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PMID:Intramural ganglion cell degeneration in inflammatory bowel disease. 91 14

Data for 500 patients with Crohn's disease who underwent operations were analyzed (316 patients, 1966 to 1969; 184 patients, 1972 to 1973) by comparison of various anatomic disease locations (clinical pattern): (1) ileocolic, 225 patients; (2) small intestinal, 130 patients; (3) colonic, 127 patients; (4) anorectal, 18 patients. Indications for surgery were tabulated and compared using statistical analysis for the three large patterns. For patients with ileocolic Crohn's disease, the primary surgical indications were internal fistula and abscess, 44%, intestinal obstruction, 35%, and perianal disease, 12%. For patients with Crohn's disease of the small intestine, the primary surgical indications were intestinal obstruction, 55%, and intestinal fistula and abscess, 32%. Patients with colonic Crohn's disease had a significantly more diverse surgical indication, with poor response to medical therapy, 26%, internal fistula and abscess, 23%, toxic megacolon, 20%, and perianal disease, 19%. These values were highly statistically significant (P less than 0.0001) in all instances but one. This study demonstrates that statistically significant differences occur in the surgical indication depending on the location of Crohn's disease. Patients with ileocolic, small intestinal, and colonic involvement have striking differences in clinical course. It is concluded that Crohn's disease is not a homogeneous entity, but should be recognized as having a varying course depending on clinical pattern.
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PMID:Indications for surgery in Crohn's disease: analysis of 500 cases. 108 41

Since 1987, 67 children with ulcerative colitis, 14 with colonic polyposis, and one with Hirschsprung's disease have undergone colectomy and endorectal ileal pullthrough procedures (ERP). Seventy-six children had a lateral ileal reservoir and six had a straight pullthrough. Seventy-seven patients had a diverting ileostomy for 4 months; five polyposis patients underwent ERP without ileostomy. Forty-three (52%) developed complications, including ileoanal stenosis with reservoir outlet obstruction (14), elongated ileal spout (2), elongated ileal reservoir greater than 15 cm (4), and a combination of outflow obstruction, reservoir enlargement causing stasis (14), and intestinal obstruction causing obstruction (10). Thirty-two children required reoperation. Sixty per cent of complications occurred in the first 30 patients. Only three of the last 40 patients had reoperation. There were no deaths. Four children (two with Crohn's disease) returned to a permanent ileostomy (4.9%); 10 had a temporary ileostomy. Five straight pullthroughs were converted to a reservoir because of stool frequency; 19 underwent reservoir reconstruction because of stasis. Seventy-five children (91.5%) are currently progressing very well. Features for optimal function include a short rectal muscle cuff, a short reservoir and spout, and aggressive correction of rectal strictures. The ERP is a desirable option to proctocolectomy and ileostomy for children with colitis or polyposis.
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PMID:Long-term results after colectomy and endorectal ileal pullthrough procedure in children. 130 89

It is clear that the nutritional state of patients with inflammatory bowel disease is often impaired and can be improved by the provision of nutritional support. Improvement in nutritional status can be achieved as effectively with enteral as with parenteral nutrition. Nutritional support appears to have no primary therapeutic effect in patients with ulcerative colitis. With regard to nutritional support in Crohn's disease, parenteral nutrition should be restricted to use as supportive rather than primary therapy. Available information now seems to suggest that most of the benefits of parenteral nutrition in Crohn's disease are related to an improvement in nutritional state rather than as primary therapy, and its use should be restricted to the treatment of specific complications of Crohn's disease, such as intestinal obstruction related to stricture formation or short bowel syndrome following repeated resection. Although some doubt exists over the efficacy of oligopeptide-containing elemental and polymeric enteral diets, the present evidence indicates that chemically defined free amino acid-containing elemental diets have primary therapeutic efficacy in the management of acute exacerbations of Crohn's disease. As such, these diets are worthy of therapeutic trial in patients with severe Crohn's disease involving the distal colon and rectum, particularly in those patients who are malnourished and who prove to be resistant to treatment with a combination of topical corticosteroids and 5-aminosalicylic acid-containing compounds. Clinicians should be aware, though, that the beneficial effects are likely to be restricted to the short term, with high relapse rates by 1 year, this being particularly so in patients with distal Crohn's proctocolitis (Teahon et al, 1988). Volatile fatty acid enemas clearly have potential in the management of patients with severe steroid-resistant proctitis. Finally, one of the most important observations made in recent years is the one concerning the large losses of nitrogen that will occur in patients with inflammatory bowel disease treated with corticosteroids in the absence of adequate protein intake (O'Keefe et al, 1989). Hopefully the days of treating patients with severe inflammatory bowel disease with high dose corticosteroids and a peripheral dextrose or dextrose-saline drip have passed into history.
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PMID:Medical management of severe inflammatory disease of the rectum: nutritional aspects. 131 93

Filiform polyposis (FP) is a rare condition of uncertain pathogenesis, 28 cases of which have been published since it was first described in 1965. It is usually found in association with chronic inflammatory bowel disease, especially Crohn's disease and ulcerative colitis. The condition is characterized by the presence of numerous, densely packed, filiform polyps in the colon, which may resemble villous adenomas on endoscopy. We describe a case of FP occurring in a 33-year-old man with a 5-year history of Crohn's disease, in whom subtotal colectomy was performed because of perforation of the sigmoid colon. Microscopy revealed inflammatory pseudopolyps covered by largely normal and non-dysplastic colonic epithelium. The neuroendocrine system of the intestine in FP was investigated for the first time in this case: marked hyperplasia of endocrine cells immunoreactive for serotonin, somatostatin and enteroglucagon and of neural structures immunoreactive for substance P and vasoactive intestinal peptide was noted in the polyps and the adjacent intestinal mucosa. The patient has experienced no further complications in the 12 months since the operation. Medication administered in FP depends mainly on the nature of the underlying disease, and the amount of information published about this condition is as yet insufficient to allow any one specific type of treatment to be recommended. FP alone is not an indication for bowel resection but complications, such as massive haemorrhage or intestinal obstruction, may necessitate surgical intervention.
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PMID:Filiform polyposis: a case report describing clinical, morphological, and immunohistochemical findings. 139 19

Ischaemic colitis has many and different clinical features as it is often linked to the severity of ischaemic injury. In this paper two patients with clinical features of Crohn's disease are reported. In both patients the diagnosis has been confirmed with endoscopy and biopsy. They have been treated with specific therapy until they developed bowel obstruction in one case and peritonitis in the other. Both patients underwent laparotomy and the histological specimen showed a picture of ischaemic colitis. In one case a Dixon's resection was done, in the other Hartmann's operation.
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PMID:[Ischemic colitis manifested as Crohn's disease. A case report]. 143 9

A retrospective analysis was made of the diagnostic period of Crohn's disease as well as of x-ray and endoscopic signs in 28 patients. Three forms of the disease were distinguished: acute (pseudoappendicular), stenosing with chronic intestinal obstruction syndrome and primary chronic characterized by the triad (pains in the stomach, diarrhea, fever) or by the syndrome of malabsorption with extraintestinal manifestations. In the stenosing and primary chronic forms of Crohn's disease, a correct diagnosis was established in the majority of the patients 3-5 years after appearance of the symptoms. To improve early diagnosis of Crohn's disease, it is recommended that indications for x-ray and endoscopic examinations be extended. These examinations are indicated in all the patients with recurrent pains in the right iliac area, fever of obscure genesis and chronic diarrhea.
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PMID:[Crohn's disease. The problem of early diagnosis]. 144 Mar 17

An individual who has cystic fibrosis (CF) may suffer from gastrointestinal problems related to inadequately controlled intestinal absorption secondary to the pancreatic insufficiency. These include neonatal meconium ileus, distal intestinal obstruction syndrome (DIOS), constipation and acquired megacolon, rectal prolapse and rarely pancreatitis. If the intestinal malabsorption is well controlled with an effective pancreatic enzyme preparation, DIOS, constipation and rectal prolapse are infrequent. Persisting gastrointestinal symptoms should be investigated thoroughly to exclude other disorders not directly related to the cystic fibrosis; these include cows' milk intolerance, coeliac disease, giardiasis, Crohn's disease and intra-abdominal malignancy. Both appendicitis and intussusception may cause difficult diagnostic problems particularly in patients who may also have distal ileal obstruction syndrome.
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PMID:Cystic fibrosis: gastrointestinal complications. 145 4


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