scholarly journals Current Elective Surgical Treatment of Inflammatory Bowel Disease

2021 ◽  
Author(s):  
Enio Chaves Oliveira ◽  
Mauro Bafutto ◽  
Alexandre Augusto Ferreira Bafutto ◽  
Salustiano Gabriel Neto ◽  
Jarbas Jabur Bittar Neto
Keyword(s):  
Inflammatory Bowel Disease ◽  
Surgical Treatment ◽  
Small Bowel ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Bowel Resection ◽  
Normal Function ◽  
Total Proctocolectomy ◽  
Patient Will ◽  
Inflammatory Bowel

The incidence of inflammatory bowel disease (IBD) is increasing world-wide and most patient will require some surgical treatment once in life. IBD surgical patients are a challenge to surgeons. Main goals of surgical treatment are (1) to preserve the small bowel integrity because many resections may lead the patient to a small bowel short syndrome and (2) restore normal function as they have absorption disturbances. IBD patients may present mal-nutrition status and/or immunosuppression at the time of surgery. Types of surgery range from a simple plasty in Crohn disease to a total proctocolectomy in Ulcerative Colitis. For Crohn disease most procedures avoid resection and use diseased segments to prevent disabsorption. Herein we describe the most currently used techniques to treat IBD patients, when to indicate surgery and how to prepare them to less outcomes. Patients with Crohn disease with high risk for short bowel syndrome and intestinal failure should be submitted to Strictureplasty otherwise, Bowel Resection is the favored surgical technique for the management of fibrostenotic. Bowel Resection is associated with lower recurrence rate and longer recurrence-free survival.

A Case of Pseudomelanosis Duodeni: Striking Endoscopic Features With Subtle but Characteristic Pathologic Findings

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S119-S120
Author(s):  
Yukihiro Nakanishi ◽  
Amber Souers ◽  
Rachna Jetly Shridhar ◽  
Kara De Felice ◽  
Byron Crawford
Keyword(s):  
Inflammatory Bowel Disease ◽  
Lamina Propria ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Rare Condition ◽  
Iron Sulfate ◽  
Total Proctocolectomy ◽  
Significant Family History ◽  
Pilonidal Cyst ◽  
Inflammatory Bowel

Abstract A 72-year-old man was referred to the inflammatory bowel disease clinic for evaluation for possible Crohn disease. The patient was diagnosed with pan-ulcerative colitis in the late 1960s. He had medically refractory disease and required a total proctocolectomy with end ileostomy in the early 1970s. Since surgery, the patient has done well with his end ileostomy and has not required any inflammatory bowel disease medications. Over the past 14 months, he has developed intermittent foul-smelling serosanguinous drainage from his previous drained pilonidal cyst. His local gastroenterologist raised the concern for possible Crohn disease with perianal involvement. He has a significant family history of Crohn disease in his father. Past medical history includes chronic kidney disease, hypertension, diabetes, coronary artery disease, gout, and arthritis. Esophagogastroduodenoscopy (EGD) revealed diffuse brown to black speckled/tigroid spots in the entire examined duodenum. Duodenal biopsy showed scattered clusters of macrophages containing dark pigmented granules within the apical tips of the lamina propria. These pigmented granules were focally positive with iron staining. No villous blunting, intraepithelial lymphocytosis, granuloma, or significant inflammation was identified. The distinctive endoscopic and histologic features are diagnostic of pseudomelanosis duodeni. Pseudomelanosis duodeni is a rare benign entity characterized by diffuse black tigroid spots and aggregates of pigment-laden macrophages in the lamina propria. Results of iron staining are characteristically variable. Pseudomelanosis duodeni is seen in middle-aged to elderly adults. Most of the patients with pseudomelanosis duodeni are asymptomatic. Although the exact etiology remains unknown, pseudomelanosis duodeni has been reported to be associated with several medical conditions such as end-stage renal disease, hypertension, diabetes, heart failure, gastrointestinal hemorrhage, and medications, including oral iron therapy, furosemide, hydralazine, thiazide, and iron sulfate. Pathologists should be aware of this rare condition of the duodenum to make an accurate diagnosis of this rare entity.

scholarly journals The Changing Phenotype of Inflammatory Bowel Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Carthage Moran ◽  
Donal Sheehan ◽  
Fergus Shanahan
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Bowel Disease ◽  
Surgical Treatment ◽  
Cancer Risk ◽  
Bowel Disease ◽  
Mortality Rates ◽  
Phenotypic Changes ◽  
Disease Mortality ◽  
Elderly Onset ◽  
Inflammatory Bowel

It is widely known that there have been improvements in patient care and an increased incidence of Inflammatory Bowel Disease (IBD) worldwide in recent decades. However, less well known are the phenotypic changes that have occurred; these are discussed in this review. Namely, we discuss the emergence of obesity in patients with IBD, elderly onset disease, mortality rates, colorectal cancer risk, the burden of medications and comorbidities, and the improvement in surgical treatment with a decrease in surgical rates in recent decades.

Clostridium Difficile Infection and Biliary Obstruction

2021 ◽  
Vol 8 (1) ◽  
pp. 01-06
Author(s):  
Marilena Stoian
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Crohn Disease ◽  
Bowel Disease ◽  
Biliary Obstruction ◽  
Hepatobiliary Disease ◽  
Protein Loss ◽  
Protein Losing Enteropathy ◽  
Inflammatory Bowel

We present a case of a 38-year -old man was admitted to the hospital with biliary obstruction and Clostridium Difficile infection. He presented with moderate increases in the aminotransferase and bilirubin levels suggesting the diagnosis of an autoimmune hepatobiliary disease; intestinal protein loss needs to evaluate an associated inflammatory bowel disease. The clinical diagnosis of autoimmune hepatobiliary disease associated with inflammatory bowel disease is based on the patients symptoms and the presence of a protein-losing enteropathy which are more suggestive of Crohn disease, while moderate increases in the aminotransferase levels in proportion to the increase in the bilirubin level suggesting the diagnosis of primary sclerosing cholangitis. The pathological and positive diagnosis needs an endoscopic retrograde cholangiopancreatography and a biopsy of gastric and duodenum mucosae who showed severe inflammation findings that are diagnostic of Crohn disease.

Predictors of Surgical Intervention in Patients with Inflammatory Bowel Disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Hamdy Abd El Megeed ◽  
Shereen Abou Bakr Saleh ◽  
Christina Alphonse Anwar ◽  
Ahmed Elkattary Mohamed Elkattary
Keyword(s):  
Inflammatory Bowel Disease ◽  
Surgical Treatment ◽  
Bowel Disease ◽  
Surgical Intervention ◽  
High Sensitivity ◽  
Medical Patients ◽  
Mayo Score ◽  
Calprotectin Level ◽  
Inflammatory Bowel ◽  
The Mean

Abstract Background Inflammatory bowel disease (IBD) is comprised of two major disorders: Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis affects the colon, where as Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Objective To determine & detect different predictors that help us to characterize patients with high probability of undergoing surgical intervention for inflammatory bowel diseases. Patients and Methods The present study was designed to detect & identify possible factors that can be used to predict surgical intervention in patients with IBD. The present study was a case control study that was conducted on 80 patients with inflammatory bowel disease (either controlled by medical treatment or needed surgical intervention as a part of disease control) who were recruited form Ain-Shams university hospitals and El Quabbary general hospital in Alexandria. In the present study, the mean age of the included patients was 36.67 ±8.5 years old and 50% of the patients were males. The mean age at the onset of the disease was 25.81 ±6.8 years old. Results In the present study, there were statistically significant differences between surgical and medical patients in terms of CDAI for CD (p < 0.001) and Mayo score for UC (p < 0.001). Surgical patients were more likely to have higher scores. CDAI and Mayo score were negative predictors of surgical treatment. CDAI score > 287 and Mayo score > 8.5 achieved high sensitivity and specificity for the detection of surgical treatment. In the present study, we found that there was statistically significant differences between surgical and medical patients in terms of Stool Calprotectin level. Surgical patients were more likely to have higher Stool Calprotectin level. Stool Calprotectin level was negative predictor of surgical treatment at a level of > 341.5 microgm/gm with high sensitivity and specificity. Conclusion Surgical treatment is a common outcome in IBD. Certain clinical features and the extent of disease are risk factors for surgical intervention. Our study indicates that smoking, Chron’s disease, perianal disease, granulomas, higher severity scores, higher stool Calprotectin level, CRP, and ESR were associated with higher risks of surgical intervention. In addition, smoking, peri-anal disease, CDAI, Mayo score, Stool Calprotectin level, and CRP level were predictors of surgical treatment. The findings of our analysis have implications for practice, particularly in the promotion of preoperative individualized risk prediction. The ability to predict which patients will need surgery and target more intensive, early treatment to that group would be invaluable. Further research through large prospective cohort studies is needed to confirm our findings and conclusions.

Diffuse Filiform Polyposis With Unique Histology Mimicking Familial Adenomatous Polyposis in a Patient Without Inflammatory Bowel Disease

2007 ◽  
Vol 131 (12) ◽  
pp. 1821-1824
Author(s):  
Gerard J. Oakley III ◽  
Wolfgang H. Schraut ◽  
Robert Peel ◽  
Alyssa Krasinskas
Keyword(s):  
Inflammatory Bowel Disease ◽  
Small Bowel ◽  
Familial Adenomatous Polyposis ◽  
Bowel Disease ◽  
Nerve Fibers ◽  
Normal Colonic Mucosa ◽  
Adenomatous Polyposis ◽  
Inflammatory Bowel ◽  
Filiform Polyposis ◽  
Vascular Hamartoma

Abstract Filiform polyposis is an uncommon entity that is most often encountered in the colon of patients with a history of inflammatory bowel disease (IBD). Filiform polyposis is characterized by a large number of “wormlike” polyps lined by histologically normal colonic mucosa. These polyps can mimic adenomatous polyps. Only rare cases without a history or evidence of IBD have been reported. Neuromuscular and vascular hamartoma of the small bowel is a rare, focal disorder characterized by disorganized smooth muscle fascicles throughout the submucosa accompanied by fibrosis, nerve fibers, ganglion cells, and vessels. To our knowledge, there is only one report of this lesion in the large bowel (cecum), where it presented as a mass. Here we report the case of a 50-year-old man with no known history or symptoms of IBD presenting with filiform polyposis involving the entire colon, clinically mimicking familial adenomatous polyposis, and showing histologic features similar to neuromuscular and vascular hamartoma of the small bowel.

Outcomes After Bowel Resection for Inflammatory Bowel Disease in the Era of Surgical Care Bundles and Enhanced Recovery

2019 ◽  
Vol 24 (1) ◽  
pp. 123-131 ◽  
Author(s):  
Anthony P. D’Andrea ◽  
Prerna Khetan ◽  
Reba Miller ◽  
Patricia Sylla ◽  
Celia M. Divino
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Bowel Resection ◽  
Enhanced Recovery ◽  
Surgical Care ◽  
Care Bundles ◽  
Inflammatory Bowel
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