CROHN’S DISEASE IN CHILDREN: THE CURRENT STATE OF THE PROBLEM

Crohn's disease (CD) is chronic recurrent bowel disease of unknown etiology, characterized by segmental transmural granulomatous inflammation, mainly with the development of local and systemic complications. Despite the active development of conservative therapy methods, the number of drug-resistant forms of CD and complications of the disease requiring surgical treatment continues to increase. The article reflects modern scientific ideas about the methods of diagnosis, conservative and surgical treatment of CD in children.

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Surgical treatment of complications of Crohn’s disease

Vestnik of Russian military medical Academy ◽

10.17816/brmma12241 ◽

2018 ◽

Vol 20 (1) ◽

pp. 111-116

Author(s):

I A Solovev ◽

A M Pershko ◽

D P Kurilo ◽

M V Vasilchenko ◽

E S Silchenko ◽

...

Keyword(s):

Crohn’S Disease ◽

Surgical Treatment ◽

Crohn's Disease ◽

Surgical Intervention ◽

Intestinal Anastomosis ◽

Clinical Manifestations ◽

Intestinal Fistula ◽

Subtotal Resection ◽

Surgical Interventions ◽

Conservative And Surgical Treatment

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.

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Aphthous stomatitis as the debut of Crohn’s disease

Experimental and Clinical Gastroenterology ◽

10.31146/1682-8658-ecg-169-9-97-100 ◽

2020 ◽

pp. 97-100

Author(s):

O. V. Gaus ◽

V. A. Akhmedov ◽

A. S. Korshunov

Keyword(s):

Crohn’S Disease ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Granulomatous Inflammation ◽

Aphthous Stomatitis ◽

Systemic Complications ◽

Immune Mediated ◽

Transmural Inflammation ◽

Retromolar Region

Crohn’s disease is an immune-mediated disease characterized by non-specific granulomatous transmural inflammation with segmental damage to any part of the gastrointestinal tract with the formation of extraintestinal and systemic complications. Clinical observation of patient I., 23 years old, a student who was sent for consultation to a gastroenterologist in the direction of a dentist, is presented. Active examination of the gastrointestinal tract during the inspection did not show any complaints. He considers himself ill for 6 months, when he first complained of pain in the neck, sore throat, and body temperature rise to 37.4–37.5 °C, mostly in the evening. Were treated by an otolaryngologist and a dentist without significant effect. In this connection, a biopsy of the ulcerative defect of the left retromolar region was performed, revealing noncaseating granulomatous inflammation. A follow-up examination by a gastroenterologist with colonoscopy and biopsy made it possible to establish Crohn’s disease as the true cause of aphthous stomatitis.

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Epithelioid Cell Granulomas in Crohn’s Disease Are Differentially Associated With Blood Vessels and Lymphatic Vessels: A Sequential Double Immunostaining Study

Journal of Histochemistry & Cytochemistry ◽

10.1369/0022155420939535 ◽

2020 ◽

Vol 68 (8) ◽

pp. 553-560

Author(s):

Makoto Kodama ◽

Daisuke Kobayashi ◽

Keiko Abe ◽

Rikisaburo Sahara ◽

Tetsuo Yamana ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Blood Vessels ◽

Lymphatic Vessels ◽

Granulomatous Inflammation ◽

Gastrointestinal Disorder ◽

Epithelioid Cell ◽

Unknown Etiology ◽

Small And Large Intestine

Crohn’s disease (CD) is a gastrointestinal disorder of unknown etiology. CD-specific longitudinal ulcers show an association between disease pathogenesis and vasculature dysfunction. Granulomatous lymphangitis may also contribute to CD pathogenesis; meanwhile, vasculitis is the primary CD lesion. We investigated the association between granulomas and lymphatic and blood vessels to assess the role of vasculature in CD pathogenesis. Two small and large intestine specimens were obtained from four CD patients. From each specimen, 160 sequential sections were obtained and double immunohistochemical stained to label lymphatic and blood vessels in association with granulomas. We found that 289 of 342 granulomas (85%) were associated with a lymphatic vessel and 313 of 364 granulomas (86%) were associated with a blood vessel. Although intrablood vessel granulomas were not detected, intralymphatic vessel granulomas were. In the internal region of the granuloma, we found more blood vessels than lymphatic vessels. Hence, these results cumulatively demonstrate that CD epithelioid cell granulomas are differentially associated with lymphatic and blood vessels, suggesting both as essential for the formation and maintenance of these granulomas. Moreover, both lymphatic and blood vessels may participate in granulomatous inflammation in the primary CD lesions; however, additional studies with larger numbers of participants are required to validate our findings.

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Perforating Crohn's Disease: Conservative and Surgical Treatment

Digestive Diseases ◽

10.1159/000353373 ◽

2013 ◽

Vol 31 (2) ◽

pp. 218-221 ◽

Cited By ~ 13

Author(s):

Gianluca M. Sampietro ◽

Silvia Casiraghi ◽

Diego Foschi

Keyword(s):

Crohn’S Disease ◽

Surgical Treatment ◽

Crohn's Disease ◽

Conservative And Surgical Treatment

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Crohn’s disease: A case report with literature review

ARS Medica Tomitana ◽

10.1515/arsm-2015-0017 ◽

2015 ◽

Vol 21 (1) ◽

pp. 32-36

Author(s):

Alexandra Maiorean ◽

Mariana Aşchie ◽

Anca Florentina Mitroi ◽

I. Poinareanu

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Medical Attention ◽

Inflammatory Disorder ◽

Systemic Complications ◽

The Past ◽

Choice Of Treatment ◽

Case Surgery ◽

History Of ◽

Local And Systemic Complications

Abstract Crohn’s disease is an idiopathic inflammatory disorder which can affect any segment of the digestive tract. Generally considered uncommon and often underestimated, it can endanger the patient’s life due to its local and systemic complications. In this article we present the case of a 67-year-old male patient who was admitted for cramping abdominal pain, nonbloody diarrhea, fever and anorexia. He described a 5-year history of similar episodes composed of the same symptoms for which he was admitted. In the past no diagnosis was confirmed and he received no treatment, due to the fact that the episodes were autolimited and the patient didn’t ask for medical attention. In this case surgery was required and the diagnosis of Crohn’s disease was histopathologically confirmed, thus leading to a proper choice of treatment to avoid possible complications.

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STRICTUREPLASTY AS AN ORGAN-SAVING METHOD IN PATIENTS WITH SMALL BOWEL CROHN'S DISEASE (case report)

Koloproktologia ◽

10.33878/2073-7556-2019-18-3-77-83 ◽

2019 ◽

Vol 18 (3(69)) ◽

pp. 77-83

Author(s):

A. V. Vardanyan ◽

M. Kh. Toboeva ◽

I. V. Zarodnyuk ◽

L. P. Orlova

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Granulomatous Inflammation ◽

Clinical Problem ◽

Surgical Approaches ◽

Large Area ◽

Systemic Complications ◽

Disease Case ◽

Wide Range

Crohn's disease (CD) is a complex, chronic recurrent disease with transmural, segmental, granulomatous inflammation in all parts of the gastrointestinal tract with high risk of local and systemic complications. The disease is progressive, despite a wide range of modern conservative and surgical approaches. One of the most common causes of surgery for CD is strictures, which are result of prolonged, non-specific inflammation and later cicatricial changes in the intestinal wall. The occurrence of strictures is a serious clinical problem, due to the lack of effective methods of diagnosis and treatment. In fact, there are two type of surgery – resection of the affected area and organ-saving procedure. At the same time, when performing extensive resections of the small bowel, the patient loses a large area of absorption surface, which often leads to the short bowel syndrome. Recently, the majority of foreign experts prefer organ-saving procedure – strictureplasty. In this paper, we present a case of successful application of this procedure for complicated form of Crohn's disease.

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Crohn’s disease of the duodenum. Clinical signs, diagnosis, conservative and surgical treatment

Orvosi Hetilap ◽

10.1556/oh.2008.28302 ◽

2008 ◽

Vol 149 (11) ◽

pp. 505-508 ◽

Cited By ~ 2

Author(s):

Péter Lukovich ◽

András Papp ◽

Péter Fuszek ◽

Tibor Glasz ◽

Hajnalka Győrffy ◽

...

Keyword(s):

Crohn’S Disease ◽

Surgical Treatment ◽

Crohn's Disease ◽

Clinical Signs ◽

Billroth Ii ◽

Conservative And Surgical Treatment

A duodenumra lokalizált Crohn-betegség az összes Crohn-betegség kb. 0,5–4%-át teszi ki. Leggyakoribb tünete a gyomorürülési zavar és a jelentős fogyás. Az endoszkópos biopszia eredménye gyakran bizonytalan, ami megnehezíti az egyéb benignus szűkületektől való elkülönítését. A műtétet igénylő megbetegedés kezelése tekintetében a betegséggel foglalkozó európai konszenzusos nyilatkozat sem ad pontos irányelveket. Beteganyag: Eredménytelen konzervatív kezelés miatt a Semmelweis Egyetem I. Sebészeti Klinikáján 2002–2007 között három betegnél a gyomorürülési panasz megoldására műtétre volt szükség. Mindegyik betegnek a műtét előtt jelentős súlyvesztése (13–30 kg) volt. Két esetben sikerült a gyulladt bélszakasz eltávolítása a duodenum parciális reszekciójával, és az emésztőtraktus Billroth-II. szerint végzett rekonstrukciójával, egy esetben a leszálló duodenum érintettsége miatt csak bypassműtétre (gastro-jejunostomia) nyílt lehetőség. Eredmények: A betegek a műtét óta eltelt 45/24/9 hónap óta panaszmentesek, műtét előtti súlyukat visszanyerték. Sem korai, sem késői szövődményt nem észleltünk. Következtetések: A konzervatív kezelésre tartósan nem reagáló, szűkületet okozó duodenalis Crohn-betegség műtéti javallatot képez, azonban a fennálló malnutritio a műtét előtt kezelést igényel. A műtét típusa előre nem tervezhető, a kellően előkészített patkóbél-Crohn-beteg gyógyhajlama nem rosszabb, mint egyéb lokalizációjú sorstársaié.

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