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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.
Dis Colon Rectum 1989 May
PMID:Synchronous bowel anastomoses. 271 24

Twenty-eight patients with vaginal fistulas complicating Crohn's disease, seen between 1970 and 1987, are described. Twelve required early operation; five of them had rectal excision. Conservative management was used in 16 patients but in none of these did the fistula close spontaneously. Subsequent proctocolectomy was required in seven patients though two patients with high vaginal fistulas were managed by total colectomy, end ileostomy, and oversewing of the rectal stump. Only two high fistulas resulting from ileal Crohn's disease resolved with resection and anastomosis of the diseased segment alone. Local repair was unsuccessful despite repeated operations in two of five patients. Two patients died of malignancy arising within a chronic vaginal fistula. Although some vaginal fistulas complicating Crohn's disease cause little disability and can be managed symptomatically, they do not heal by conservative therapy or by a proximal defunctioning stoma alone. In time, severe bowel symptoms develop in the majority of patients and necessitate proctectomy.
Dis Colon Rectum 1989 May
PMID:Vaginal fistulas in Crohn's disease. 271 28

Between September 1959 and December 1986, a total of 210 patients in a consecutive series were operated on for inflammatory bowel disease. One hundred ten (66 percent) had ileorectal anastomosis performed. There were no postoperative deaths. There were six failures in 53 ileorectal anastomoses for ulcerative colitis (11 percent), and five failures (8 percent) in 61 for Crohn's disease. The overall failure rate was 11 in 110 (10 percent). Ileorectal anastomosis, in suitable patients, is still a viable operation in the late 1980s.
Dis Colon Rectum 1989 May
PMID:Current status of ileorectal anastomosis for inflammatory bowel disease. 271 32

Spontaneous umbilical fistula in Crohn's disease is extremely rare, with very few reports found on a 15-year review of the medical literature. Among those reports, no patient had prior abdominal surgery. Attention was recently focused on this unique entity when spontaneous umbilical fistula was diagnosed in a 64-year-old anemic male mechanic with known ileocolic Crohn's disease. This fistula locus occurred despite a right lower quadrant appendectomy incision done 15 years earlier. Spontaneous umbilical fistula pathophysiology and pathways are reviewed.
Dis Colon Rectum 1989 Jul
PMID:Spontaneous umbilical fistula in Crohn's disease. Report of a case. 273 64

In order to determine whether perioperative blood transfusion affects the recurrence of Crohn's disease, the authors reviewed the records of 79 patients with Crohn's disease who underwent their initial intestinal resection at their institution. Recurrence of Crohn's disease was documented by radiographic studies, endoscopy, or laparotomy. During the hospital admission for resection, 45 patients received multiple red blood cell transfusions. Recurrence developed in 22 percent of these patients by 36 months, and the median time to recurrence was 35 months. In the 34 patients who did not receive multiple transfusions, recurrence was found in 44 percent by 36 months, and the median time to recurrence was 20 months. These differences are significant, using the Kaplan-Meier analysis (P less than 0.04). Recurrence in patients with disease limited to the small bowel or to the colon was not significantly affected by the transfusion status. However, recurrence developed in only 10 percent of multiply transfused patients with ileocolic disease by 36 months, whereas recurrence developed in 45 percent of the patients who were not multiply transfused. (Significance, P = 0.057). The authors believe that the observed decreased rate of recurrence of Crohn's disease in patients receiving multiple perioperative transfusions may represent another example of clinically significant immunosuppression from blood transfusion.
Dis Colon Rectum 1989 Sep
PMID:Multiple blood transfusions reduce the recurrence rate of Crohn's disease. 275 43

Rectovaginal fistulas in the setting of Crohn's disease present a difficult management dilemma. Some patients with this problem require proctocolectomy, yet other patients with minimal symptoms never require an operation for treatment of the rectovaginal fistula. For a small percentage of patients, local surgical repair of the fistula may be warranted. Since 1980, this study has attempted local repair in seven patients with symptomatic rectovaginal fistulas from Crohn's disease. Five patients underwent staged repair of the fistula. Closure of the colostomy was eventually possible in three of these patients. Two of the three patients have had no evidence of recurrence at followup in excess of two years. The third patient required an ileostomy for intestinal disease and had no recurrence of the fistula. Two patients underwent primary repair of the rectovaginal fistula without fecal diversion; in one of these patients, the fistula recurred ten days after operation, necessitating a diverting ileostomy. The other patient remains cured 26 months after repair. The results of this review indicate that in the setting of quiescent rectal disease, an attempt to repair the fistula can be expected to have a reasonable chance of success. The presence of a rectovaginal fistula in a patient with Crohn's disease does not mandate removal of the rectum.
Dis Colon Rectum 1989 Oct
PMID:Rectovaginal fistula in Crohn's disease. 279 65

The experience of the senior author has been reviewed in dealing with perianal fistulas in patients with Crohn's disease. Early surgical therapy was advocated, the theory being, that perianal fistulas start as intersphincteric fistulas. This fistula is easily controlled surgically by fistulotomy with partial internal and sphincterotomy. Delay in surgical treatment, especially in Crohn's patients, results in more complicated fistulas that may require colostomy or proctectomy. The presence of Crohn's disease did not affect the healing of fistulotomy. In our series fistulotomy was the treatment of choice in patients with 26 fistulas; 18 of 19 went on to full healing. We conclude that early fistulotomy, before an intersphincteric fistula has time to blossom into a more difficult management problem, is the treatment of choice in patients with Crohn's disease who have perianal fistulas.
Dis Colon Rectum 1989 Oct
PMID:Experience with perirectal fistulas in patients with Crohn's disease. 279 70

Nine cases of gastric fistula occurring in patients with Crohn's disease were treated at The Mount Sinai Hospital over the past three decades. Six cases were found in a review of 1480 patients with Crohn's disease admitted between 1960 and 1983. Three others seen at this institution outside the time frame of the author's study have also been included. Among six new cases, five with cologastric fistula occurred among 907 patients with Crohn's disease involving the colon (0.6 percent), while only one with ileogastric fistula was encountered among 1211 patients with ileal disease (0.08 percent). Fistulas between the stomach and colon always originated in an area of colitis, usually passing from distal transverse colon to greater curvature, but occasionally from midtransverse colon to antrum. The only pathognomonic clinical features were feculent vomiting, eructations, or odor. Diagnosis usually was made by barium enema or, less frequently, by upper gastrointestinal series; rarely, the gastric fistula was found unexpectedly at surgery. The conventional and recommended therapy is colectomy with wedge excision of the stomach. Medical treatment with 6-mercaptopurine has been completely successful in one patient and intermittently successful in a second patient.
Dis Colon Rectum 1989 Oct
PMID:Gastric fistulas in Crohn's disease. Report of cases. 279 74

A retrospective review of patients with Crohn's disease treated at our institution from 1973 to 1986 revealed 35 patients operated upon for anorectal fistulas. Twenty-nine had low intermuscular fistulas (multiple in seven), and six had high intermuscular (supralevator) fistulas. Fistulotomy alone was performed in 19 patients, and eight underwent partial fistulotomy and seton insertion. Five additional patients had proximal fecal diversion before fistulotomy. Three patients with severe colonic and anorectal disease underwent proctocolectomy as the initial procedure. Of the 32 patients who had fistulotomy performed, complete healing occurred in 30. Seven patients who healed required more than one operation for fistula. One patient was left with an asymptomatic fistula, and one required proctectomy for persistent symptomatic fistula and proctitis. Success of operation correlated with absence of rectal disease and quiescent disease elsewhere in the gastrointestinal tract. Aggressive medical treatment is required to control bowel disease preoperatively. In the majority of patients, subsequent surgery is justified and healing can be anticipated.
Dis Colon Rectum 1989 Jun
PMID:Surgical management of anorectal fistulas in Crohn's disease. 279 86

A retrospective review of patients with Crohn's disease treated at our institution from 1973 to 1986 revealed 12 patients operated on for rectovaginal fistula. Disease involved the large intestine in 10 patients. Primary fistula repair was performed in four patients and four others had staged repair with preliminary fecal diversion. Four patients with severe colonic and anorectal disease had proctocolectomy performed as the first procedure. Of eight patients who underwent fistula repair, complete healing occurred in six. One patient has a persistent fistula, which is minimally symptomatic, and the other required proctocolectomy after three unsuccessful repairs. Success of operation correlated with quiescent intestinal disease and absence of rectal involvement. In selected patients with symptomatic fistulas, surgical repair is indicated and healing can be anticipated.
Dis Colon Rectum 1989 Jun
PMID:Results of operation for rectovaginal fistula in Crohn's disease. 279 87


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