CONSERVATIVE MANAGEMENT OF ACUTE INTESTINAL OBSTRUCTION IN CROHN'S DISEASE

Background: Intestinal obstruction continues to be a common surgical emergency throughout the world and its management protocol has evolved over years. In our study we aimed to provide a complete epidemiological description of intestinal obstruction in adult age group patients in a tertiary care hospital in Northern India.Methods: This is a prospective study of patients belonging to age group more than 12 years admitted in our unit with clinical features suggestive of intestinal obstruction from September 2011 to December 2013 at R. N. T. Medical College, Udaipur. The study comprised of 134 patients.Results: Intestinal obstruction contributed to 6.5% of all surgical admissions. It was nearly twice more common in males. 43% patients presented with features of acute intestinal obstruction in comparison to 57% who presented with features of sub-acute intestinal obstruction. Most common cause observed was obstruction due to intra-abdominal adhesions followed by abdominal tuberculosis 48 and 29 percent respectively. Features of intestinal obstruction resolved in 60% patients with conservative management. Adhesions, abdominal tuberculosis and malignancy counted for majority of patients with sub-acute obstruction. Emergency surgery was done in 32% of patients and 36.5 % of patients were discharged non-operatively. Planned Surgery after successful expectant management was done in 24 % patients. Most frequently seen complication was wound site collection (72.5%) followed by respiratory tract infections (49%). Total mortality in our study was 12.6% of which 41% was post-operative mortality and 59% mortality seen in patients who expired during conservative management. Conclusions: This study demonstrates that intra-abdominal adhesions and abdominal tuberculosis account for most cases of intestinal obstruction in countries like India. A watchful expectant management can be tried in patients with prior operative history and those with history of tuberculosis.

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A case of intestinal obstruction by a fruit pit in a healthy individual leading to the diagnosis of Crohn's disease

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2000.02946.x ◽

2000 ◽

Vol 95 (9) ◽

pp. 2581-2581

Author(s):

D. Kaufman ◽

M. Lazinger ◽

S. Fogel ◽

S.K. Dutta

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Obstruction ◽

Healthy Individual

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Strategy for Removing an Impacted Enterolith using Double-Balloon Enteroscopy in Crohn’s Disease

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002266 ◽

2021 ◽

Author(s):

Tatsuya Kikuchi ◽

Yasushi Yamasaki ◽

Tsuyoshi Fujimoto ◽

Shoichi Tanaka

Keyword(s):

Crohn’S Disease ◽

Surgical Treatment ◽

Crohn's Disease ◽

Intestinal Obstruction ◽

Endoscopic Treatment ◽

Double Balloon Enteroscopy ◽

Balloon Enteroscopy ◽

Double Balloon

An enterolith in Crohn’s disease is an uncommon but serious condition because it can cause intestinal obstruction. Endoscopic treatment to remove the enterolith is attempted first, but is sometimes difficult owing to poor accessibility of the endoscope. In such cases, surgical treatment is inevitable. We successfully overcame poor accessibility and removed an enterolith using double-balloon enteroscopy. We describe our method below and suggest several helpful techniques.

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All that fistulises is not Crohn’s disease : Multiple entero-enteric fistulae in intestinal tuberculosis

Polish Journal of Surgery ◽

10.5604/01.3001.0012.8269 ◽

2019 ◽

Vol 91 (1) ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Harjeet Singh ◽

Harshal Mandavdhare ◽

Vishal Sharma

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Obstruction ◽

Intestinal Tuberculosis ◽

Abdominal Tuberculosis ◽

Clinical Scenarios ◽

Intestinal Involvement ◽

Initial Improvement ◽

Anti Tubercular Therapy ◽

Intestinal Ulcers

Abdominal tuberculosis is a common problem for clinicians in the tropical world and may manifest with varying clinical scenarios. Intestinal tuberculosis could have intestinal ulcers, strictures, hypertrophic lesions like polyps and may be complicated by perforation, bleeding, and intestinal obstruction. Crohn’s disease is an important differential of intestinal tuberculosis which is closely mimics intestinal tuberculosis in clinical, endoscopic, radiological and histological presentation. Crohn’s disease is known to have a fistulising variant. We report the case of 23 year old lady who had disseminated tuberculosis with intestinal involvement and seemed to improve on anti-tubercular therapy (ATT) but present with intestinal obstruction in the third month of ATT. Surgical exploration revealed clumping of bowel loops with multiple ileo-ileal fistulae. The case is presented because of the presence of entero-enteric fistulae and also because it demonstrated that intestinal tuberculosis may need surgical intervention even after initial improvement because of complications like intestinal obstruction.

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