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

A retrospective review of patients who underwent double bowel resections and synchronous anastomoses without ileostomy or colostomy was undertaken. The study goal was to determine whether there was an increased incidence of complications attributable to the presence of a second anastomosis. A total of 66 patients who met the criteria were identified and divided into two groups. Group A consisted of 30 patients who had had two colonic resections and two colonic anastomoses. In Group B were 36 patients who had undergone separate colonic and small-bowel resections with two subsequent anastomoses. The indications for primary resection were: 1) adenocarcinoma, 54 percent; 2) Crohn's disease, 26 percent; 3) diverticulitis, 11 percent; 4) "other" indications, 9 percent. The indications for the second resection were: 1) metastatic adenocarcinoma, 30 percent; 2) Crohn's disease, 26 percent; 3) synchronous bowel lesions, 18 percent; 4) adhesions and enterotomies, 14 percent; 5) "other" indications, 12 percent. Overall, there were four major complications (6 percent), and 11 minor complications (17 percent). The sole anastomotic leak occurred in a patient who had undergone a double colonic resection (3%). The other major complications were one death, one ureteral complication that required reoperation, and one early small-bowel obstruction. Minor complications included two wound infections (3 percent), three seromas (5 percent), three prolonged ileus (5 percent), and three urinary infections (5 percent). These results are comparable to the best results reported for patients undergoing single colonic anastomoses. The conclusion is that it is safe to perform synchronous anastomoses without diversion provided the following conditions are present: well-prepared bowel with minimal fecal soilage, an adequate blood supply, technically good anastomoses, and lack of tension on the suture lines.
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PMID:Synchronous bowel anastomoses. 271 24

Fifty patients with fibrotic small bowel strictures secondary to long-standing Crohn's disease underwent a total of 225 strictureplasties during the period from June 1984 to July 1988. Forty-two patients (84%) presented with obstructive symptoms. Patients had a 1- to 30-year history of Crohn's disease (mean, 14 years). Sixty-two per cent of patients were taking steroids at the time of admission, and 70% had had previous small bowel resections. All patients had one or more areas of small bowel affected with a fibrotic stricture and partial obstruction. Short strictures were treated by Heinecke-Mikulicz strictureplasties, and longer strictures by Finney side-to-side strictureplasties. In 30 patients (60%), 6- to 65-cm segments of small bowel were also resected due to acute inflammation with phlegmon or fistulae. Patients were discharged from the hospital 5 to 20 days after operation (mean, 10 days). After operation all patients with obstructive symptoms reported relief of symptoms and weight gain. Steroid doses could be tapered and nutritional parameters, such as total lymphocyte count, and serum albumin improved. Strictureplasty had 0% mortality and 16% morbidity rates. Complications included 3 enterocutaneous fistulae, 2 intra-abdominal abscesses, 2 hemorrhages requiring transfusion, 1 prolonged postoperative ileus that could be treated conservatively in 2 patients, and 1 restricture of a strictureplasty. Patients were followed for 1 to 40 months after operation (mean, 8 months). Resection of small bowel disease, especially that associated with perforation, is usually required in Crohn's disease. However, strictureplasty minimizes the need for bowel resection in patients with short fibrotic strictures resulting in recurrent small bowel obstruction.
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PMID:Strictureplasty in Crohn's disease. 281 31

The physical inconvenience and adverse psychological impact of ileostomy on patients led surgeons to seek a more normal and acceptable alternative. This is a report of the Mayo Clinic experience with, and modifications of, the ileoanal reservoir procedure. The hospital charts of 188 patients who had a J-pouch construction were reviewed. The operative technique is described. There were no hospital deaths. In 10 patients the operation was a failure. Complications included pelvis sepsis (21 patients), anastomotic sinus (15), anastomotic stricture (22), small-bowel obstruction (43), peritonitis after ileostomy closure (10) and pouchitis (15). Careful patient selection for the procedure is important. Crohn's disease is a contraindication. Of the patients studied, 95% found life more acceptable with an ileoanal anastomosis than with a loop ileostomy.
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PMID:J pouch with ileoanal anastomosis. 282 16

Eighty-five patients aged 40 or less who presented with colorectal carcinoma over a 32-year period were reviewed. The incidence was 2.5 per cent of all patients with large bowel cancer (n = 3426). Predisposing causes included familial polyposis (eight patients), panprotocolitis (ulcerative, one, Crohn's, one) and irradiation (one), four patients were pregnant, one-third of the patients presented as emergencies, and 43 per cent of these had intestinal obstruction. Five-year survival rates were 41 per cent overall and 59 per cent after "curative" resection. Survival was equivalent both for elective and emergency admission and for mucinous carcinomas (n = 16) and those non-mucinous carcinomas of moderate histological differentiation. Five-year survival rates were poorer when the history was less than three months in duration (20 per cent vs 45 per cent: P = 0.02) and for rectal and rectosigmoid tumours than colonic tumours (31 per cent vs 50 per cent: P = 0.05). Radical resection is indicated when feasible: four of five patients with involvement of adjacent viscera and four of six patients with resectable recurrence survived beyond 10 years. The outcome is similar to that at all ages, any unfavourable pathological features being balanced by improved survival following emergency operations.
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PMID:Large bowel cancer in the young. 282 93

During the six-year period between January 1981 and January 1987, 582 ileal pouch-anal anastomoses were constructed at the Mayo Clinic-affiliated hospitals for either ulcerative colitis (509 patients) or polyposis coli (71 patients). Two patients had Crohn's disease. Two patients died postoperatively. Pelvic sepsis, intestinal obstruction, and pouchitis were seen in 4%, 13%, and 14%, respectively. At one year postoperatively, the mean number of stools was 5.6 during the day and 1.5 during the night. Younger patients and those with polyposis had fewer stools. Incontinence was observed in 2% patients during the day and 3% during the night. Ileal pouch-anal anastomosis is safe, provides satisfactory continence, and improves the quality of life of patients who require proctocolectomy.
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PMID:The ileal pouch-anal anastomosis: surgical technique and current clinical results. 282 95

Ulcerative colitis (UC) and Crohn's disease (CD) can lead to perforation, abscesses and peritonitis. In such cases conservative treatment should only be secondary to surgery, whereas intensive conservative treatment is needed from the very start in toxic megacolon. The decision to operate must be made within 24-48 h. Partial or complete intestinal obstruction is frequently encountered in CD patients if the ileum is involved. Prednisone treatment can sometimes reverse this condition when combined with parenteral nutrition. Treatment of acute exacerbations of UC and CD is essentially conservative and consists of salazosulfapyridine or 5-aminosalicylic acid and prednisone.
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PMID:[Acute manifestations in Crohn disease and ulcerative colitis. Conservative treatment of acute situations]. 290 77

An 86-year-old woman who developed small bowel adenocarcinoma 40 years following in-continuity bypass of a 60-cm segment of regional ileitis represents the 22nd reported patient with this complication of bypassed Crohn's disease. Her case demonstrates several of the typical clinical features of such cancers: late recrudescence of disease following a 40-year period of relative quiescence; delayed diagnosis due to misinterpretation of the clinical picture (intestinal obstruction, abdominal mass, intraabdominal abscess, and fistula formation) as due to inflammatory bowel disease; and an exceedingly poor prognosis with rapid widespread local dissemination and death. Histologically, severe dysplasia was demonstrated both in close proximity to and at a distance from the lesion. The increasing number of case reports of adenocarcinoma arising at the site of long-standing Crohn's disease, many with dysplasia within areas of diseased bowel, is further evidence that Crohn's disease is a precancerous condition. Physicians must continue to search for methods of earlier diagnosis to improve the prognosis of small bowel carcinoma in Crohn's disease.
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PMID:Small bowel carcinoma in Crohn's disease. Distinguishing features and risk factors. 291 Apr 43

Intestinal volvulus in patients with Crohn's disease is rare and we could find only one report of sigmoid volvulus with active Crohn's colitis. We have seen a 54-year-old woman with long-standing Crohn's disease who developed large-bowel obstruction. After eventual detorsion of the sigmoid volvulus, we found that her ileum was involved with active Crohn's disease and that her colonic mucosa was free of mucosal lesions. In this case, we suspect that the reactivation of the ileal Crohn's disease as well as other features commonly associated with Crohn's disease contributed to the development of sigmoid volvulus by causing fixation, torsion, and dilatation of distal bowel.
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PMID:Sigmoid volvulus as a complication of ileal Crohn's disease. 292 96

Seventy patients with non-stenosing Crohn's disease were randomly assigned to follow a low residue diet or a normal Italian diet for a mean of 29 months. The two groups were comparable at the onset in various measures of disease severity and diet. Patients complied well with the diet prescriptions, the low residue group eating a mean of 8.1 portions a week of fibre containing foods and the liberalized group a mean of 26.6 portions (p less than 0.005). There was no difference in outcome between the two groups, including symptoms, need for hospitalisation, need for surgery, new complications, nutritional status, or postoperative recurrence. Eighty six per cent of patients eating ad libitum and 65% of patients who avoided roughage eliminated one or more permitted foods because of subjective intolerance. Lifting of dietary restrictions, which results in a more appetizing and nutritious diet, does not cause symptomatic deterioration or precipitate intestinal obstruction in Crohn's disease.
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PMID:Low residue or normal diet in Crohn's disease: a prospective controlled study in Italian patients. 299 91

Crohn's disease is a rare disease in Korea, and only 45 cases have been reported during the period of 34 years from 1952 to 1985. The male to female ratio was about 1.3 to 1 with a slight preponderance of males. The age at diagnosis ranged from 8 to 72 (mean 35.5) years, and the peak incidence occurred in the 3rd, 4th and 5th decades and declined thereafter. More than two thirds of the cases had a grossly demonstrable lesion involving the small bowel, including the terminal ileum. The proportion of patients with macroscopic disease continued to the large bowel alone was only 15%. Abdominal pain was common, presenting in 89% of the patients, while such symptoms as fever, hematochezia and diarrhea were not common. Abdominal mass was palpable in more than half the cases, which made it difficult to differentiate Crohn's disease from cancer of the colon, especially in cases with a predominant infiltration of the bowel wall and a secondary ulcer formation. That is one of the reasons why most cases in Korea have been reported by surgeons. A wide variety of complications were present, of which small bowel obstruction was the most common. Other complications were free perforation, malnutrition, fistula formation, hemorrhage and abscess formation, in decreasing order. The incidence of symptomatic perianal disease was only 11%, and this might be due to the small proportion of the disease confined to large bowel. Extraintestinal manifestations were also rare, and only three patients presented symptoms of arthritis. Other systemic features such as liver disease, skin lesion, eye complications were absent.
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PMID:Clinical features of Crohn's disease in Korea. 321 41


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