Vesico-intestinal fistula and crohn's disease

Possibilities and options of surgical treatment of complications of Crohn’s disease in the general surgical hospital are considered. Patients underwent various surgical interventions: ileum resection with «side-to-side» anastomosis (4 patients), resection of ileocecal department with the formation of ileoascendoanastomosis (2 patients), total coloproctectomy with the formation of ileostomy (2 patients), right-sided hemicolectomy (1 patient), obstructive resection of transverse colon (1 patient), obstructive resection of sigmoid colon (2 patients). Postoperative complications developed in 3 patients (25%), among them: postoperative wound suppuration - 2, dehiscence of anastomosis in 1 patient, which led to the formation of internal intestinal fistula and death. It was found that with limited lesions of colon in Crohn’s disease (less than a third of the colon) can be limited to resection of the affected segment with formation of intestinal anastomosis in the limits of healthy tissues. In the presence of lesions in the ascending department of colon proximal border of resection should be at the level of middle colic vessels with preservation of the latter. In long Crohn’s disease of colon with severe clinical manifestations of the operation of choice is a subtotal resection of colon with the imposition of single-barrel ileostomy. Surgical treatment of complicated forms of Crohn’s disease is in all cases performed in surgical profile hospitals, taking patients by ambulance. Most often, patients have delayed indications for operations, which gives the opportunity to carry out a comprehensive preoperative preparation. In all cases, complications of Crohn’s disease requires an individual approach, which combines conservative and surgical treatment. Surgical intervention is determined by the shape and characteristics of the course of complications of Crohn’s disease.

Download Full-text

Prevalence of Sarcopenia and Its Effect on Postoperative Complications in Patients with Crohn’s Disease

Gastroenterology Research and Practice ◽

10.1155/2021/3267201 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Chen Zhang ◽

Dingye Yu ◽

Liwen Hong ◽

Tianyu Zhang ◽

Hua Liu ◽

...

Keyword(s):

Crohn’S Disease ◽

Postoperative Complications ◽

Crohn's Disease ◽

Bowel Resection ◽

Demographic Data ◽

Laboratory Data ◽

Intestinal Fistula ◽

Tertiary Referral Center ◽

Preoperative Serum

Background and Aims. Sarcopenia is a prognostic factor of outcomes for various diseases, but reports on sarcopenia in patients with Crohn’s disease (CD) are few. We aim to determine the prevalence of sarcopenia and assess the role of sarcopenia in postoperative complications in patients with CD at a tertiary referral center. Methods. Patients who underwent intestinal surgery for CD from January 2013 to October 2019 were retrospectively enrolled. The L3 skeletal muscle mass index (SMI) was used to identify sarcopenia. Demographic data, preoperative laboratory data, surgical details, and hospital outcomes were recorded. The factors associated with postoperative complications were evaluated through univariate and multivariate analyses. Results. One hundred and twenty-four patients were enrolled. Thirty-four of them (27.4%), including 11 males, were diagnosed with sarcopenia. Compared with patients without sarcopenia, sarcopenic patients had a significantly lower BMI ( P < 0.001 ); lower preoperative serum albumin ( P = 0.006 ), prealbumin ( P = 0.030 ), and hemoglobin levels ( P < 0.001 ); longer hospital stay ( 34.4 ± 26.8 days vs. 22.8 ± 15.6 days, P = 0.003 ); and more occurrences of complications (41.2% vs. 23.3%, P = 0.049 ). The overall incidence of postoperative complications was 28.2%. Infection (51.4%) and intestinal fistula (22.9%) were the most common among such complications. Through the multivariate analysis, sarcopenia was identified as an independent risk factor for major postoperative complications ( odds ratio = 3.974 , 95 % CI = 1.171 –13.489, P = 0.027 ). Conclusion. Sarcopenia is common in patients with CD requiring bowel resection, and it significantly increases the risk of major postoperative complications.

Download Full-text

Hemorrhage from the inferior epigastric artery malformation into the external intestinal fistula as an atypical complication of Crohn's disease

Journal of Crohn s and Colitis ◽

10.1016/j.crohns.2012.06.018 ◽

2013 ◽

Vol 7 (1) ◽

pp. e26-e27 ◽

Cited By ~ 1

Author(s):

Beata Jabłońska ◽

Andrzej Lekstan ◽

Paweł Lampe ◽

Joanna Pilch-Kowalczyk

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Fistula ◽

Inferior Epigastric Artery ◽

Epigastric Artery

Download Full-text

Prevalence of Sarcopenia and Its Effect on Postoperative Complications in Patients With Crohn’s Disease

10.21203/rs.3.rs-418354/v1 ◽

2021 ◽

Author(s):

Chen Zhang ◽

Dingye Yu ◽

Liwen Hong ◽

Tianyu Zhang ◽

Hua Liu ◽

...

Keyword(s):

Crohn’S Disease ◽

Postoperative Complications ◽

Crohn's Disease ◽

Bowel Resection ◽

Demographic Data ◽

Laboratory Data ◽

Intestinal Fistula ◽

Tertiary Referral Center ◽

Preoperative Serum

Abstract Background and Aims: Sarcopenia is a prognostic factor of outcomes for various diseases, but reports on sarcopenia in patients with Crohn’s disease (CD) are few. We aim to determine the prevalence of sarcopenia and assess the role of sarcopenia in postoperative complications in patients with CD at a tertiary referral center.Methods: Patients who underwent intestinal surgery for CD from January 2013 to October 2019 were retrospectively enrolled. The L3 skeletal muscle mass index (SMI) was used to identify sarcopenia. Demographic data, preoperative laboratory data, surgical details, and hospital outcomes were recorded. The factors associated with postoperative complications were evaluated through univariate and multivariate analyses.Results: One hundred and twenty-four patients were enrolled. Thirty-four of them (27.4%), including 11 males, were diagnosed with sarcopenia. Compared with patients without sarcopenia, sarcopenic patients had a significantly lower BMI (P<0.001); lower preoperative serum albumin (P=0.006), pro-albumin (P=0.030), and hemoglobin levels (P<0.001); longer hospital stay (34.4±26.8 days vs. 22.8±15.6 days, P=0.003); and more occurrences of complications (41.2% vs. 23.3%, P=0.049). The overall incidence of postoperative complications was 28.2%. Infection (51.4%) and intestinal fistula (22.9%) were the most common among such complications. Through the multivariate analysis, sarcopenia was identified as an independent risk factor for major postoperative complications (odds ratio=3.974, 95% CI=1.171–13.489, P=0.027).Conclusion: Sarcopenia is common in patients with CD requiring bowel resection, and it significantly increases the risk of major postoperative complications.

Download Full-text

Ultrasound-Guided Percutaneous Drainage of Abdominal Abscess in a Patient With Crohn's Disease: A Case Report

Frontiers in Surgery ◽

10.3389/fsurg.2021.616586 ◽

2021 ◽

Vol 8 ◽

Author(s):

Radmila V. Karpova ◽

Ksenia S. Russkova ◽

Roman N. Komarov ◽

Arina A. Petrova

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Fibrin Glue ◽

Intravenous Administration ◽

Immune Status ◽

Diagnostic Algorithm ◽

Abscess Cavity ◽

Intestinal Fistula ◽

Lower Quadrant ◽

The Right

Introduction: The autoimmune process in Crohn's disease exacerbates destructive changes in the intestinal wall and leads to complications such as bleeding (21. 9%), strictures (21.6%), and abscesses (19.7%).Case Presentation: The case of a 32-year-old male patient with an 8-year history of Crohn's disease is presented. He was admitted for emergency indications with severe pain in the right lower quadrant, chills, and a fever reaching 39.0°C. The patient had anemia, hypocoagulation and immunodeficiency. Ultrasound and CT scans of the abdominal organs revealed an abscess in the right iliac region. It was immediately drained under ultrasound control and X-ray. A fistulogram showed the fistula between the abscess and the ileum. Routine antibiotic therapy selected in accordance with the sensitivity of the microflora and sanitization of the abscess cavity were not effective. The immunomodulatory therapy, intravenous administration of cryoprecipitate, and the introduction of fibrin glue into the abscess cavity were added to the treatment. After the treatment, the patient's immune status corresponded to normal, the abscess healed, and the fistula was closed.Conclusion: In patients suffering from Crohn's disease with the formation of an abscess and a long-term non-healing intestinal fistula, it is essential that the diagnostic algorithm includes the examination of the immune status. Treatment should include immunomodulators, intravenous administration of cryoprecipitate. To close the fistula in these patients, it is advisable to use fibrin glue that has a local immunomodulatory effect.

Download Full-text

Difficult cases of differential diagnosis of acute appendicitis

Research n Practical Medicine Journal ◽

10.17709/2410-1893-2021-8-3-12 ◽

2021 ◽

Vol 8 (3) ◽

pp. 133-139

Author(s):

L. A. Otdelnov ◽

A. M. Mastukova

Keyword(s):

Differential Diagnosis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Acute Appendicitis ◽

Young Patient ◽

Right Hemicolectomy ◽

Greater Omentum ◽

Intestinal Fistula ◽

First Case ◽

The Right

Despite the results of technological progress in medicine, which has made high-resolution methods of medical imaging available, the problem of differential diagnosis of acute appendicitis does not lose its’ relevance. This can be explained by the fact that the symptoms of acute appendicitis are variable, non-specific, and can mimic other diseases with similar symptoms.Three cases of rare diseases of the gastrointestinal tract that simulates acute appendicitis were presented. Those are primary torsion of the greater omentum with necrosis, caecum cancer with lengthy necrosis in a young patient and Crohn's disease that simulates appendicular infiltrate. All patients underwent surgery. Signs of acute appendicitis were indications for surgery. Laparoscopic resection of greater omentum was performed in the first case. In the second case caecum necrosis with peritonitis was revealed by laparoscopy. Conversion laparoscopy to laparotomy was performed. Caecum necrosis with caecum wall perforation and necrosis of terminal part of the ileum was diagnosed. right hemicolectomy with ileo-transverso anastomosis was carried out. Complicated case of Crohn’s disease was suspected. Nevertheless, the diagnosis of colorectal cancer is established by pathomorphology only. This case is interesting because of rare complication of colon cancer – the caecum and the ileum wall necrosis that was manifestation of the disease. In the third case of Crohn’s disease in a young patient the diagnosis of appendicular infiltrate and surgical policy were wrong. At the first laparotomy by McBurney was performed. A dense infiltrate was found in the right iliac fossa. The intervention was finished by local abdominal package. In the early postoperative period an intestinal fistula was formed. The patient underwent relaparotomy and right hemicolectomy with ileo-transversal anastomosis was carried out. Despite the diagnosis of Crohn's disease was questionable patomorphology and was established after half a year only by colonoscopy. The presented cases illustrate the complexity of acute appendicitis and the importance of modern approaches to diagnosis: irreplaceability of laparoscopy and the feasibility of using diagnostic scales. When the right diagnosis is not clear the intervention might be late for using methods of instrumental diagnostics.

Download Full-text

Clinical and Radiologic Characteristics of Intra-Abdominal Fistulizing Crohn’s Disease

Digestion ◽

10.1159/000501514 ◽

2019 ◽

Vol 101 (6) ◽

pp. 667-673

Author(s):

Ariel A. Benson ◽

Eyal Aviran ◽

Shaul Yaari ◽

Naama Lev-Cohain ◽

Jacob Sosna ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Medical Records ◽

Common Type ◽

Intestinal Fistula ◽

Imaging Studies ◽

Patient Age ◽

Patient Âgé ◽

Average Patient ◽

Radiologic Characteristics

Background: Few studies describe the radiological and laboratory characteristics of patients with Crohn’s disease (CD) with intra-abdominal fistulae. Objectives: We aimed to describe a cohort of CD patients with intra-abdominal fistulae and determine characteristics associated with complex fistulae. Methods: Data were gathered from medical records and imaging studies of patients. Evaluation included type of fistula, number of fistulae, and radiological characteristics. Results: A total of 205 fistulae in 132 patients were identified with an average patient age of 31 (±12) years. The average time from CD diagnosis to fistula development was 7 years. The most common type of fistula was entero-enteric (53%). Patients with an extra-intestinal fistula presented with an average of 1.96 fistulae, compared with an average of 1.28 fistulae for those with a fistula limited to the bowel (p =0.01). Except for the number of fistula no other significant differences were observed in radiological characteristics of patients who were diagnosed with a fistula at time of CD diagnosis compared to those diagnosed with a fistula later. Conclusions: The most common CD-associated intra-abdominal fistulae are entero-enteric and entero-colonic fistulae. An extra-intestinal fistula and diagnosis of a fistula subsequent to diagnosis of CD were associated with an increased number of fistulae per patient.

Download Full-text