Abdominopelvic CT-scan in emergency departments for patients with suspected complications of Crohn’s disease: a single tertiary center experience

Abstract Background Crohn’s disease (CD) is a chronic disorder with frequent complications. The objective of this study was to assess the predictive factors of finding a complication of CD using abdominopelvic CT-scan in patients with a visit to the emergency department. Methods Patients with at least one visit to the gastroenterology department of our University hospital during the year with a CD were retrospectively included. All visits to the emergency department of the hospital during the follow-up of these patients were identified. Results A total of 638 patients were included and 318 (49.8%) had at least one visit to the emergency department since the beginning of their follow-up. Abdominopelvic CT-scan was performed in 141 (23.7%) of the 595 visits for digestive symptoms. Only 4.3% of these CT-scans were considered as normal; there was luminal inflammation without complication in 24.8%, abscess, fistula or perforation in 22.7%, mechanical bowel obstruction in 36.9% and diagnosis unrelated to CD in 11.3%. In univariate analysis, stricturing phenotype (OR, 2.48; 95% CI, 1.16–5.29; p = 0.02) and previous surgery (OR, 2.90; 95% CI, 1.37–6.14; p = 0.005) were predictive factors of finding a complication of CD using abdominopelvic CT-scan, whereas no independent predictive factor was statistically significant in multivariate analysis. Conclusion In CD patients consulting in emergency department, CT-scan examination was performed in 24% of visits for digestive symptoms and complications of CD were found in 60%. Complications were more frequent in patients with stricturing phenotype and previous surgery.

Download Full-text

P720 Recurrent rectovaginal fistula in patients with Crohn’s disease: How can we improve the success rate of graciloplasty? A bi-centric European study in 30 patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.848 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S579-S580

Author(s):

A Frontali ◽

M Rottoli ◽

A Chierici ◽

G Poggioli ◽

Y Panis

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Antibiotic Prophylaxis ◽

Success Rate ◽

Rectovaginal Fistula ◽

Univariate Analysis ◽

Diverting Stoma ◽

Prospective Database

Abstract Background Graciloplasty (GP) is indicated in case of recurrent rectovaginal fistula (RVF), even in patients with Crohn’s disease, after failure of previous local treatments. The aim of this study was to evaluate risk factors for GP failure performed for recurrent RVF in these patients. Methods We realised a retrospective study based on a prospective database of GP, realised in two Tertiary expert Centers in Italy (Bologna) and France (Clichy). Results Thirty-two patients undergoing 34 GP (2 patients have undergone 2 GP for failure of first GP): we excluded second GP and 2 patients without available follow-up: 30 patients undergoing a first GP for RVF (n = 29) or ileal-vaginal fistula after ileal-pouch-anal-anastomosis (IPAA) (n = 1) with a mean age of 41 ± 10 years (range, 25–64) were analysed. After a mean follow-up of 65 ± 52 months (2–183), a success of GP (considered as absence of diverting stoma and RVF healing) was noted in 17/30 patients (57%). We evaluated risk factors for failure of the procedure and we found only 2 risk factors on univariate analysis: (1) absence of a postoperative prophylactic antibiotherapy: only 2/13 (15%) patients with a GP failure had a postoperative antibiotic-prophylaxis vs. 9/15 (60%) patients with success of GP (p = 0.0238); (2) a postoperative perineal infection: 7/13 (54%) with a GP failure developed a postoperative perineal infection vs. 2/17 (12%) patients (p = 0.0196). Conclusion Graciloplasty for recurrent rectovaginal fistula in patients with Crohn’s disease is effective in 57% of patients. Our study underlines the possible benefit of a postoperative antibiotic-prophylaxis because it seems to increase significantly the success rate of the procedure.

Download Full-text

Su1931 Clinical Predictors of Urgent Findings on Abdominopelvic CT in Emergency Department Patients With Crohn's Disease

Gastroenterology ◽

10.1016/s0016-5085(12)62070-8 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-539

Author(s):

Caroline Kerner ◽

Kathleen Carey ◽

Angela M. Mills ◽

Wei Yang ◽

Charles A. Baillie ◽

...

Keyword(s):

Emergency Department ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Predictors ◽

Abdominopelvic Ct ◽

Emergency Department Patients

Download Full-text

Follow up of more than 10 years after strictureplasty for jejunoileal Crohn’s disease: long‐term results and predictive factors for outcome

Colorectal Disease ◽

10.1046/j.1463-1318.1999.00031.x ◽

1999 ◽

Vol 1 (2) ◽

pp. 101-106 ◽

Cited By ~ 6

Author(s):

Yamamoto ◽

Keighley

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Predictive Factors ◽

Long Term Results

Download Full-text

Machine learning for prediction of intra-abdominal abscesses in patients with Crohn’s disease visiting the emergency department

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211053114 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110531

Author(s):

Asaf Levartovsky ◽

Yiftach Barash ◽

Shomron Ben-Horin ◽

Bella Ungar ◽

Shelly Soffer ◽

...

Keyword(s):

Machine Learning ◽

Emergency Department ◽

Crohn’S Disease ◽

Random Forest ◽

Crohn's Disease ◽

Biologic Therapy ◽

Abdominal Imaging ◽

Random Forest Model ◽

Forest Model ◽

Tertiary Center

Background: Intra-abdominal abscess (IA) is an important clinical complication of Crohn’s disease (CD). A high index of clinical suspicion is needed as imaging is not routinely used during hospital admission. This study aimed to identify clinical predictors of an IA among hospitalized patients with CD using machine learning. Methods: We created an electronic data repository of all patients with CD who visited the emergency department of our tertiary medical center between 2012 and 2018. We searched for the presence of an IA on abdominal imaging within 7 days from visit. Machine learning models were trained to predict the presence of an IA. A logistic regression model was compared with a random forest model. Results: Overall, 309 patients with CD were hospitalized and underwent abdominal imaging within 7 days. Forty patients (12.9%) were diagnosed with an IA. On multivariate analysis, high C-reactive protein (CRP) [above 65 mg/l, adjusted odds ratio (aOR): 16 (95% CI: 5.51–46.18)], leukocytosis [above 10.5 K/μl, aOR: 4.47 (95% CI: 1.91–10.45)], thrombocytosis [above 322.5 K/μl, aOR: 4.1 (95% CI: 2–8.73)], and tachycardia [over 97 beats per minute, aOR: 2.7 (95% CI: 1.37–5.3)] were independently associated with an IA. Random forest model showed an area under the curve of 0.817 ± 0.065 with six features (CRP, hemoglobin, WBC, age, current biologic therapy, and BUN). Conclusion: In our large tertiary center cohort, the machine learning model identified the association of six clinical features (CRP, hemoglobin, WBC, age, BUN, and biologic therapy) with the presentation of an IA. These may assist as a decision support tool in triaging CD patients for imaging to exclude this potentially life-threatening complication.

Download Full-text

Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn’s Disease Presenting to the Emergency Department

Digestive Diseases and Sciences ◽

10.1007/s10620-014-3298-9 ◽

2014 ◽

Vol 60 (4) ◽

pp. 929-935 ◽

Cited By ~ 8

Author(s):

Yoon Suk Jung ◽

Dong Il Park ◽

Sung Noh Hong ◽

Eun Ran Kim ◽

Young Ho Kim ◽

...

Keyword(s):

Emergency Department ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominopelvic Ct

Download Full-text

A Validated Score Assessing the Risk of an Intra-Abdominal Abscess in Patients with Crohn’s Disease Presenting at the Emergency Department

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz043 ◽

2019 ◽

Vol 13 (9) ◽

pp. 1131-1137

Author(s):

Tawfik Khoury ◽

Saleh Daher ◽

Muhammad Massarwa ◽

David Hakimian ◽

Ariel A Benson ◽

...

Keyword(s):

Emergency Department ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Predictive Value ◽

Univariate Analysis ◽

Abscess Formation ◽

Abdominal Abscess ◽

Retrospective Case ◽

Cross Sectional ◽

Diagnostic Score

AbstractBackground and AimsA majority of acutely ill Crohn’s disease [CD] patients who present to Emergency Department [ED] will undergo an abdominal CT to rule out disease complications. We aimed to generate a simple non-invasive scoring model to predict the presence of an intra-abdominal abscess in CD patients in the ED.MethodsWe performed a retrospective case–control study at four Israeli hospitals from January 1, 2010 to May 30, 2018. Inclusion criteria included patients with an established diagnosis of CD that had cross-sectional abdominal imaging performed. A total of 322 patients were included, and 81 [25%] were diagnosed with an intra-abdominal abscess.ResultsIn univariate analysis, ileo–colonic location (odds ratio [OR] 1.88, p = 0.0148), perianal CD [OR 7.01, p = 0.0004], fever [OR 1.88, p = 0.0247], neutrophil-to-lymphocyte ratio [OR 1.12, p < 0.0001], and C-reactive protein [OR 1.10, p < 0.0001] were significantly associated with abscess formation, whereas current use of corticosteroids was negatively associated with abscess formation [OR 0.46, 95% CI, 0.2–0.88, p = 0.0192]. We developed a diagnostic score that included five parameters that were significant on multivariate regression analysis, with assignment of weights for each variable according to the coefficient estimate. A low cut-off score of ≤7 was associated with a negative predictive value [NPV] of 93% for abscess formation, whereas a high cut-off score of >9 was associated with a positive predictive value of 65%. We validated this score with an independent cohort [area under the curve of 0.881 and NPV of 98.5%].ConclusionWe recommend incorporating this score as an aid for stratifying acutely ill CD patients in the ED with low or high probability of the presence of an intra-abdominal abscess.

Download Full-text