Longer small bowel segments are resected in emergency surgery for ileocaecal Crohn’s disease with a higher ileostomy and complication rate

Abstract Background Repeated intestinal resections may have disabling consequences in patients with Crohn’s disease even in the absence of short bowel syndrome. Our aim was to evaluate the length of resected small bowel in patients undergoing elective and emergency surgery for ileocolic Crohn’s disease. Methods A prospective observational study was conducted on patients undergoing surgery for ileocolonic Crohn’s disease in a single colorectal centre from May 2010 to April 2018. The following patients were included: (1) patients with first presentation of ileocaecal Crohn’s disease undergoing elective surgery; (2) patients with ileocaecal Crohn’s disease undergoing emergency surgery; (3) patients with recurrent Crohn’s disease of the distal ileum undergoing elective surgery. The primary outcomes were length of resected small bowel and the ileostomy rate. Operating time, complications and readmissions within 30 days were the secondary outcomes. Results One hundred and sixty-eight patients were included: 87 patients in the elective primary surgery group, 50 patients in the emergency surgery group and 31 in the elective redo surgery group. Eleven patients (22%) in the emergency surgery group had an ileostomy compared to 10 (11.5%) in the elective surgery group (p < 0.0001). In the emergency surgery group the median length of the resected small bowel was 10 cm longer than into the group having elective surgery for primary Crohn’s disease. Conclusions Patients undergoing emergency surgery for Crohn’s disease have a higher rate of stoma formation and 30-day complications. Laparoscopic surgery in the emergency setting has a higher conversion rate and involves resection of longer segments of small bowel.

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Emergency and elective surgery for small bowel Crohn’s disease

Techniques in Coloproctology ◽

10.1007/s10151-011-0728-y ◽

2011 ◽

Vol 15 (S1) ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

C. Kosmidis ◽

G. Anthimidis

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Elective Surgery

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S1178 CT Enterography Findings Correlate with Tissue Inflammation But Not Fibrosis in Resected Small Bowel Crohn's Disease

Gastroenterology ◽

10.1016/s0016-5085(08)60900-2 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-195

Author(s):

Jeremy Adler ◽

Darashana Punglia ◽

Jonathan R. Dillman ◽

Alexandros D. Polydorides ◽

Mahmoud M. Al-Hawary ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Ct Enterography ◽

Tissue Inflammation ◽

Resected Small Bowel

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Ileus caused by small bowel, ileocaecal and rectal endometriosis misdiagnosed as Crohn’s disease and managed by synchronous ileocaecal and rectal resection

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0118 ◽

2020 ◽

Vol 102 (8) ◽

pp. e205-e208

Author(s):

G Popivanov ◽

D Stoyanova ◽

A Fakirova ◽

M Konakchieva ◽

D Stefanov ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Bowel Obstruction ◽

Recurrent Abdominal Pain ◽

Uneventful Recovery ◽

Emergency Setting ◽

Oral Contrast ◽

Intestinal Endometriosis ◽

Synchronous Resection

The reported incidence of intestinal endometriosis varies between 22% and 37%, with bowel obstruction in only 2.3% of cases, but few series report acute obstruction. We report a rare case of acute bowel obstruction due to multiple bilateral deep intestinal endometriosis lesions localised in the ileum, ileocaecal valve and upper rectum, requiring synchronous resection in an emergency setting. A 42-year-old woman was referred to our clinic with a diagnosis of obstructing Crohn’s disease based on abdominal computed tomography with oral contrast showing a thickened terminal ileum with stenosis, compression of the caecum and proximally dilated small bowel loops. Simultaneous ileocaecal resection and segmental resection of the upper rectum with handsewn end-to-end anastomosis between the sigmoid colon and rectum was performed. Owing to the advanced bowel obstruction and significant weight loss, a double barrelled ileoascendostomy was created. The patient had an uneventful recovery. Histological examination revealed transmural endometriosis with involvement of the pericolic fat in both specimens. Although intestinal endometriosis causing acute bowel obstruction is rare, it should be included among the differential diagnoses in young women with recurrent abdominal pain, intermittent diarrhoea and constipation without a family history for inflammatory bowel disease or cancer. Bleeding synchronous with menstruation is not typical for intestinal endometriosis. Right-sided intestinal endometriosis more frequently causes acute bowel obstruction, in most cases due to intussusception.

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