suMMARY In a series of 360 patients with Crohn's disease 18 % have developed a complication of abscess and/or fistula. Both complications can be spontaneous but more commonly occur in patients who have had a previous operation. There is a high incidence of fistula after laparotomy without resection of diseased bowel. Simple drainage of an abscess is usually followed by a fistula and fistulae do not close spontaneously. The optimal surgical treatment for fistula and for deep abscess is excision in continuity with the diseased segment of intestine. This paper reports the incidence, natural history, and our experience in treating the complications of abdominal abscess and fistula in a series of patients with Crohn's disease. Perianal disease and early postoperative complications, settling on conservative measures, have been excluded from this study. We consider abscess and fistula to be part of the same pathological process, namely, the extramural extension of a fissure-ulcer. If this remains localized in an intraperitoneal space it forms an abscess, if it ulcerates into adjacent viscera or to the surface it becomes a fistula. alt-hough some abscesses occur within a month of operation most present months or even years later. The majority of these abscesses have been shown to be due to recurrent disease. However, in three patients, two with pelvic and one with a subphrenic abscess, all of whom presented several years after operation, there was no evidence of recurrent disease and the abscesses must have been direct complications of these operations.Forty-nine patients were found to have a total of 60 fistulae. The site of presentation has been classified as either externally to the skin or vagina-42 patients (11 %) or internally to another viscus 18 patients (5 %). Thirty-six of the 42 external fistulae were in direct communication with the small bowel, whereas only six were involving the large intestine.
SUMMARY An assessment has been made of 25 patients who have undergone ileorectal anastomosis for Crohn's disease. The rate of anastomotic leakage was high (32%) but was fatal in only one patient. The likelihood of leakage was not affected by a safety valve ileostomy, failure to excise all diseased bowel, or steroid therapy. The overall recurrence rate was 60 per cent. This was not affected by the age of the patient, duration of the disease, steroid therapy, or anastomotic leak but was affected adversely by the presence of concurrent small bowel disease and by residual rectal disease at the site of the anastomosis.It might be thought that the known tendency for Crohn's disease to recur would preclude conservative surgery of the large bowel in this disease. Nonetheless successful results have been claimed for ileorectal anastomosis (Jones, Lennard-Jones, and Lockhart-Mummery, 1966;Hawk, Turnbull, and Schofield, 1970). This paper reports an enquiry into the long-term progress of patients with Crohn's disease of the colon treated by ileorectal anastomosis at the General Hospital, Birmingham. MaterialThere were 25 patients, all of whom had Crohn's disease of the colon histologically confirmed. There were 12 men and 13 women who were followed up over a mean period of 76 months, the range being from 14 to 24 months. Methods PART IBy using short-term morbidity (anastomotic leak) and long-term recurrence as indices, an assessment has been made of the efficacy of some aspects of the surgical and medical management. These are the effect of a 'safety valve' ileostomy; the effect of unavoidably leaving diseased bowel at the level of the anastomosis; the prognostic significance of an anastomotic leak; and the effect of steroid therapy.Received for publication 3 November 1970. PART 2Again, using the above indices, an assessment has been made of the criteria originally used in the selection of each patient for ileorectal anastomosis, namely, the age of the patient; the duration of the disease; the extent of the disease; the presence of perianal disease; and the sigmoidoscopic findings. PART 3Lastly a report has been made of the mortality among the patients; the fate of the patients who required a second operation; and the progress of the patients in this series in whom the operation was 'successful'. Results PART 1There was a proven leak from the anastomotic site in eight patients (32 %), one of whom also developed intestinal obstruction. The leaks occurred between three and five days after operation and were treated by ileostomy and drainage in two, drainage alone in two, and by non-operative management in four patients. The response to treatment was satisfactory in all except one patient who had also developed intestinal obstruction and subsequently died.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.