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

Congenital and acquired diverticula of the jejunum and ileum in the adult are unusual and occur in approximately 1 percent to 2 percent of the population. They are pulsion diverticula thought to be the result of intestinal dyskinesia. These lesions can produce a significant diagnostic and therapeutic dilemma. They are multiple in the jejunum and solitary distally and are characteristically found in 60- or 70-year-old males. The diagnosis may be confirmed with contrast studies of the small intestine, arteriography, or nuclear scan. Consider these disorders in patients with 1) unexplained gastrointestinal bleeding, 2) unexplained intestinal obstruction, 3) an unexpected cause of acute abdomen, 4) chronic abdominal pain, 5) anemia, or 6) malabsorption. Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy is reserved for hemorrhage, obstruction, perforation, or failure of medical management. Asymptomatic diverticula discovered on routine contrast studies need not be resected. At surgery, incidental diverticula should be removed when evidence of dilated, hypertrophied loops of small bowel with large diverticula is found. Intraoperative air distention will aid in diagnosis. Resection and primary anastomosis is the preferred treatment for non-Meckelian diverticula. Diverticulectomy is reserved for a Meckel's diverticulum without evidence of ulceration. An incidental Meckel's diverticulum should be removed in the presence of mesodiverticular bands or ectopic tissue. Removal of a Meckel's diverticulum is not advised in the patient with Crohn's disease but may be performed in the patient undergoing restorative proctocolectomy for ulcerative colitis.
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PMID:Clinical implications of jejunoileal diverticular disease. 158 62

Crohn's disease of the small intestine is usually managed by medical therapy with surgery being reserved for obstruction or fistula formation. A patient is described who developed small bowel obstruction due to an adenocarcinoma of the ileum after over twenty years of medical therapy for Crohn's disease, originally diagnosed at a laparotomy for acute abdominal pain. The possibility of malignancy in such long-standing disease should be considered.
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PMID:Small bowel adenocarcinoma complicating Crohn's disease. 160 69

A 54-yr-old man with a 22-yr history of Crohn's disease was found to have a microscopic focus of immunoblastic lymphoma within a segment of small bowel resected to relieve intestinal obstruction. There was no other clinically evident disease. Thirty months later, he developed axillary adenopathy with recurrent lymphoma of the same immunophenotype (IgA lambda) and was given combination chemotherapy, with complete clinical response. Lymphoma recurred 6 months later in the axilla and progressed rapidly over the next 3 months, despite chemotherapy. He developed extensive mediastinal, mesenteric, and retroperitoneal disease with malignant ascites and died 39 months after diagnosis of the incidentally discovered bowel mucosal primary tumor.
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PMID:Primary intestinal lymphoma in Crohn's disease: minute tumor with a fatal outcome. 161 47

Crohn's disease is rare in Mexico. The regarding of this pathology at Gastrointestinal Unit of the General Hospital of Mexico city, between january 1980 and december 1989, is presented. There were six cases of Crohn's disease, two women (33%) and four men (66%). The definitive diagnosis was done preoperatively only in one case, the other were diagnosed postoperatively. In all, intestinal obstruction was the surgical indication. A patient died (16.6%), three cases were followed for 12 months, only two patients are still under surveillance after 15 months.
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PMID:[Crohn disease. Medico-surgical experience. A 10-year retrospective study]. 162 Oct 34

Ischaemic colitis is a relatively rare but well-defined disease entity. It is associated with high mortality rate if early diagnosis and adequate surgical treatment is not accomplished. The aim of the present study was a clinical analysis of 7 patients with the verified ischaemic colitis. The delay from admission to the correct diagnosis was 8 days on the average (range 2-15 days). The reasons for delayed diagnosis included suspicion of diverticulitis, Crohn's disease and bowel obstruction as well as poor general condition in one case because of which early colonoscopy was not done. It is concluded that in patients with abdominal pain, rectal bleeding and diarrhoea associated with typical clinical findings, ischaemic colitis should be suspected. This suspicion should be followed by early colonoscopy to detect the gangrenous form of the disease as early as possible. Instant laparotomy and excision of the affected bowel is necessary for cure in these patients.
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PMID:Ischaemic colitis--a clinical study of seven patients with special emphasis on diagnostic problems. 175 91

We report an audit of outcome on 24 patients (16 females) who had a strictureplasty to treat ileo-colic anastomotic strictures. All except one patient had their original resection for Crohn's disease, and required reoperation because of symptoms of recurrent intestinal obstruction for a mean 9.3 months (range 1-36); the remaining patient was discovered to have ileo-colic anastomotic stricture before he underwent laparotomy for closure of loop ileostomy. At operation, four patients needed additional small bowel strictureplasties, two of whom also underwent small bowel resection for separate areas of phlegmonous disease. There was no post-operative mortality, three patients developed wound infection and one had a pelvic abscess, which settled on antibiotic therapy. Two patients have since died of unrelated disease. Five patients have since needed reoperation for recurrence; only one had a stricture at the site of previous strictureplasty. Over a mean follow-up of 70.8 months (range 18-393) all 22 living patients now have complete relief of symptoms.
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PMID:Strictureplasty for ileo-colic anastomotic strictures in Crohn's disease. 177 Feb 90

The authors studied the data concerning 101 patients who had undergone erroneous laparotomy for suspected acute surgical disease; these accounted for 0.4% of all the patients who were operated on for emergency indications in the same period. Eleven patients died. The operation was undertaken for an erroneous diagnosis of acute appendicitis (32 patients), acute cholecystitis (18), perforating gastric ulcer (15), peritonitis of unknown etiology (14), acute intestinal obstruction (5), strangulated hernia (3), destructive pancreatitis (3), tumor of the large intestine complicated by obstruction (3), abdominal abscess (2), thrombosis of the mesenteric vessels (1), ovarian apoplexy (1), closed abdominal trauma with injury to the viscera (4 patients). Diseases simulating the clinical picture of "acute abdomen" but not requiring an emergency operation were as follows: female reproductive (20 patients), pancreatic (11), renal diseases (11), hepatitis, cirrhosis of the liver (10), cardiovascular (9), pulmonary diseases (5), mesoadenitis (5), Crohn's disease (3), chronic colitis (3), carcinomatosis of the peritoneum (3), herpes zoster (3), and other diseases and injuries (20 patients). The main causes of the diagnostic and tactical errors were objective difficulties in the differential diagnosis due to similar symptomatology, as well as errors in the examination of the patient and haste in making a decision to make an operation.
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PMID:[Erroneous laparotomy in emergency surgery]. 177 33

The ileal pouch-anal anastomosis has become a practical alternative to proctocolectomy for the treatment of ulcerative colitis and polyposis coli. To evaluate its success, the Emory University Affiliated Hospital experience from February 1984 to March 1989 was retrospectively reviewed. There were a total of 50 patients identified; 84 per cent had ulcerative colitis, and 16 per cent had polyposis coli (familial polyposis and Gardner's syndrome). The majority of these patients underwent a two-stage operation, but one-third required a three-stage procedure due to difficulty in mucosal proctectomy or toxic megacolon. J-pouch construction was performed in 72 per cent of patients, S-pouch construction in 14 per cent, straight ileo-anal anastomosis in 8 per cent, and lateral isoperistaltic ileo-anal anastomosis in 6 per cent. Of the 50 patients, 36 (72%) have had closure of the temporary ileostomy. Fourteen patients have not had ileostomy closure due to change in diagnosis to Crohn's disease, operative complications, or ileostomy closure pending. The combined operative morbidity per patient for the ileal pouch-anal anastomosis and the closure of the ileostomy was 32 per cent. This included bowel obstruction, 16 per cent; pelvic abscess, 6 per cent; and ileo-anal separation, 4 per cent. Follow-up on patients with ileostomy closure ranged from 6 months to 4 years (mean, 1.3 years). Stool frequency was 5.9 stools per 24 hours at 6 months and improved with time. During the follow-up period, all patients were eventually completely continent of stool during the day, and most became completely continent of stool at night.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ileal pouch-anal anastomosis. The Emory University experience. 184 28

Nutritional and clinical responses to three nutritional regimens were retrospectively evaluated in 81 Crohn's patients with active disease. Group 1 (n = 42) received a low residue oral diet, group 2 (n = 15) received chemically defined diets, and group 3 (n = 24), parenteral nutrition (PN). Weight gain was observed in a similar percentage of patients, whereas serum albumin increase was significant only in group 3: 3.15 +/- 0.66 versus 3.54 +/- 0.61 g/100 ml (p less than 0.05). Mean activity index decreased significantly in all groups (p less than 0.001), and length of stay in hospital was similar. Patients with intestinal obstruction had a better immediate response when submitted to PN: clinical remission was achieved in 75% of those in group 3, but in only 50% in groups 1 and 2 (p less than 0.05). Otherwise, short- and long-term outcome was similar.
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PMID:Nutritional support in Crohn's disease: which route? 190 Jan 43

Four patients with Crohn's disease were treated with an elemental diet during pregnancy. Two had active disease and two also had symptoms of small intestinal obstruction. All went into a clinical remission within a few days of starting treatment. Treatment periods varied from two to four weeks, and were followed by elemental diet as a supplement to normal food in two patients. At term, all delivered a healthy infant. These patients indicate that elemental diet is a safe form of treatment for Crohn's disease during pregnancy and may be considered as an alternative to conventional drug treatments which carry a theoretical risk of teratogenesis.
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PMID:Elemental diet in the management of Crohn's disease during pregnancy. 191 96


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