Surgical management of pyogenic complications of Crohnʼs disease

Cellini, Christina; Safar, Bashar; Fleshman, James W.

doi:10.1002/ibd.20984

Cited by 20 publications

(18 citation statements)

References 80 publications

(80 reference statements)

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“…Intraabdominal abscesses or pelvic abscesses occur at some point in 10 to 30% of patients with Crohn's disease throughout the whole natural history of the disease [87-89]. Intraabdominal abscesses, which occur in patients with Crohn's disease, show a chronic nature, and simultaneously entero-enteric, entero-peritoneal and entero-cuataneous fistulas can occur.…”

Section: Surgical Management Of Inflammatory Bowel Diseasementioning

confidence: 99%

A Comprehensive Review of Inflammatory Bowel Disease Focusing on Surgical Management

Baik

2012

J Korean Soc Coloproctol

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The two main diseases of inflammatory bowel disease are Crohn's disease and ulcerative colitis. The pathogenesis of inflammatory disease is that abnormal intestinal inflammations occur in genetically susceptible individuals according to various environmental factors. The consequent process results in inflammatory bowel disease. Medical treatment consists of the induction of remission in the acute phase of the disease and the maintenance of remission. Patients with Crohn's disease finally need surgical treatment in 70% of the cases. The main surgical options for Crohn's disease are divided into two surgical procedures. The first is strictureplasty, which can prevent short bowel syndrome. The second is resection of the involved intestinal segment. Simultaneous medico-surgical treatment can be a good treatment strategy. Ulcerative colitis is a diffuse nonspecific inflammatory disease that involves the colon and the rectum. Patients with ulcerative colitis need surgical treatment in 30% of the cases despite proper medical treatment. The reasons for surgical treatment are various, from life-threatening complications to growth retardation. The total proctocolectomy (TPC) with an ileal pouch anal anastomosis (IPAA) is the most common procedure for the surgical treatment of ulcerative colitis. Medical treatment for ulcerative colitis after a TPC with an IPAA is usually not necessary.

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Section: Surgical Management Of Inflammatory Bowel Diseasementioning

confidence: 99%

A Comprehensive Review of Inflammatory Bowel Disease Focusing on Surgical Management

Baik

2012

J Korean Soc Coloproctol

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“…This will allow the inflammation associated with the septic process to resolve, thereby allowing for a limited resection and a possible one-stage operation at a later date [16] . Delaying surgery also allows time for optimizing nutritional status and reducing or stopping corticosteroids [17,18] . If the abscess is drainable by PAD, the next step is to aspirate the collection in order to demonstrate the nature of the fluid [19] .…”

Section: Computed Tomography Guided Percutaneous Abscess Drainagementioning

confidence: 99%

“…Golfieri et al [8] found that only 12.6% of 70 patients developed a recurrent abscess after a mean follow-up of 39 mo and that only 5/11 of these patients required urgent surgery. As mentioned, patients with fistula are likely to recur and should undergo surgery [18] .…”

Section: Timing Of Surgerymentioning

confidence: 99%

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Management of abdominal and pelvic abscess in Crohn’s disease

Richards

2011

WJGE

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Patients with Crohn's disease may develop an abdominal or pelvic abscess during the course of their illness. This process results from transmural inflammation and penetration of the bowel wall, which in turn leads to a contained perforation and subsequent abscess formation. Management of patients with Crohn's related intra-abdominal and pelvic abscesses is challenging and requires the expertise of multiple specialties working in concert. Treatment usually consists of percutaneous abscess drainage (PAD) under guidance of computed tomography in addition to antibiotics. PAD allows for drainage of infection and avoidance of a two-stage surgical procedure in most cases. It is unclear if PAD can be considered a definitive treatment without the need for future surgery. The use of immune suppressive agents such as anti-tumor necrosis factor-α in this setting may be hazardous and their appropriate use is controversial. This article discusses the management of spontaneous abdominal and pelvic abscesses in Crohn's disease.

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“…CD is also associated with colorectal cancer (CCR), with a cumulative risk of 2.9% at 10 years . The mainstay of therapy for CD is medical management, while surgery is reserved for cases where there are complications, neoplasia or refractoriness to medical therapy . However, about one‐third of CD patients will undergo abdominal surgery within the first 5 years of diagnosis .…”

Section: Introductionmentioning

confidence: 99%

Review article: optimal preparation for surgery in Crohn's disease

Spinelli

Allocca

Jovani

et al. 2014

Aliment Pharmacol Ther

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This commissioned review article was subject to full peer-review and the authors received an honorarium from Wiley, on behalf of AP&T. SUMMARY BackgroundOne-third of Crohn's disease (CD) patients will undergo abdominal surgery within the first 5 years of diagnosis. AimTo review the available evidence on pre-operative optimisation of CD patients. MethodsThe literature regarding psychological support, radiological imaging, abdominal abscess management, nutritional support, thromboembolic prophylaxis and immunosuppression in the perioperative setting was reviewed. ResultsFor diagnosis of fistulas, abscesses and stenosis, ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) have a high diagnostic accuracy. Under either CT or US guidance, it is possible to perform abscess percutaneous drainage (PD), which, with systemic antibiotic therapy, should be the first-line approach to intra-abdominal abscesses. CD patients with weight loss <10% within the last 3-6 months, body mass index < 18.5 kg/m 2 and/or albumin levels <30 g/L, are at an increased risk of post-operative complications. Pre-operative nutritional support should be used in these patients. IBD patients undergoing surgery have a higher risk of venous thromboembolic disease than patients with colorectal cancer, and current guidelines recommend that they should receive prophylaxis with heparin. Whether the use of anti-TNF agents before surgery increases the likelihood of post-operative complications, is the subject of much debate. To date, cumulative evidence from most studies (all retrospective) suggests that there is no such risk increment. Prospective studies are necessary to firmly establish this conclusion. ConclusionsPreparation for surgery requires close interaction between surgeons, gastroenterologist, radiologists, psychologists and the patient. Correct pre-operative planning of surgical treatment has a major impact on the outcome of such treatment.

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Surgical management of pyogenic complications of Crohnʼs disease

Cited by 20 publications

References 80 publications

A Comprehensive Review of Inflammatory Bowel Disease Focusing on Surgical Management

A Comprehensive Review of Inflammatory Bowel Disease Focusing on Surgical Management

Management of abdominal and pelvic abscess in Crohn’s disease

Review article: optimal preparation for surgery in Crohn's disease

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