WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

Simone, Belinda De; Davies, R. Justin; Chouillard, Élie; Saverio, Salomone Di; Hoentjen, Frank; Tarasconi, Antonio; Sartelli, Massimo; Biffl, Walter L.; Ansaloni, Luca; Coccolini, Federico; Chiarugi, Massimo; de’Angelis, Nicola; Moore, Ernest E.; Kluger, Yoram; Abu‐Zidan, Fikri M.; Sakakushev, Boris; Coimbra, Raúl; Celentano, Valerio; Wani, Imtiaz; Pintar, Tadeja; Sganga, Gabriele; Carlo, Isidoro Di; Tartaglia, Dario; Pikoulis, Manos; Cardi, Maurizio; Moya, Marc A. de; Leppäniemi, Ari; Kirkpatrick, Andrew W.; Agnoletti, Vanni; Poggioli, Gilberto; Carcoforo, Paolo; Baiocchi, Gian Luca; Catena, Fausto

doi:10.1186/s13017-021-00362-3

Cited by 40 publications

(59 citation statements)

References 117 publications

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“…Crohn´s disease (CD) is a chronic and relapsing inflammatory bowel disease characterized by transmural inflammation which can result in fistulae and intraabdominal abscess formations [ 1 , 2 ]. Therapeutic strategies for intraabdominal abscesses that occurs in up to 30% of patients suffering from Crohn´s disease include antibiotic treatment, interventional drainage, and surgical approaches [ 3 , 4 , 5 , 6 , 7 , 8 ]. International guidelines recommend a step-up approach with a combination of (empiric) antibiotic therapy and percutaneous CT- or ultrasound-guided drainage, if technically possible, to delay or even avoid surgery for intestinal resection [ 6 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Kusan

Surat

Kelm

et al. 2022

JCM

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Intraabdominal abscess formation occurs in up to 30% of patients suffering from Crohn´s disease (CD). While international guidelines recommend a step-up approach with a combination of empiric antibiotic therapy and percutaneous drainage to delay or even avoid surgery, evidence about microbial spectrum in penetrating ileitis is sparse. We retrospectively assessed outcomes of 46 patients with terminal penetrating Ileitis where microbial diagnostics have been performed and compared microbial spectrum and antibiotic resistance profile of CD patients with patients suffering from diverticulitis with intraabdominal abscess formation. In both groups, the most frequently isolated pathogen was the gram-negative bacterium E. coli belonging to the family of Enterobacterales. However, overall Enterobacterales were significantly more often verifiable in the control group than in CD patients. Furthermore, microbial analysis showed significant differences regarding isolation of anaerobic pathogens with decreased frequency in patients with CD. Subgroup analysis of CD patients to evaluate a potential influence of immunosuppressive therapy on microbial spectrum only revealed that Enterobacterales was less frequently detected in patients treated with steroids. Immunosuppressive therapy did not show any impact on all other groups of pathogens and did not change antibiotic resistance profile of CD patients. In conclusion, we were able to demonstrate that the microbial spectrum of CD patients does differ only for some pathogen species without increased rate of antibiotic resistance. However, the empiric antibiotic therapy for CD-associated intra-abdominal abscess remains challenging since different points such as local epidemiological and microbiological data, individual patient risk factors, severity of infection, and therapy algorithm including non-surgical and surgical therapy options should be considered before therapeutical decisions are made.

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Section: Introductionmentioning

confidence: 99%

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Kusan

Surat

Kelm

et al. 2022

JCM

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“…One particular study suggested a 23% perforation rate in patients with non-mechanical cecal dilation greater than 14 cm [10]. The mortality rate has been estimated to be 20%-50% once perforation occurs [11,12]. Other complications are associated with megacolon and include peritonitis with the development of sepsis, mesenteric ischemia, and compression of the vena cava [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Non-toxic Megacolon Secondary to High-Grade Large-Bowel Obstruction

Mullen¹,

Thurn²,

Karr³

et al. 2022

Cureus

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A 92-year-old male presented from an outside hospital for treatment of a chronic obstructive pulmonary disease exacerbation (COPD) and subsequently developed worsening abdominal distention with pain during the course of his hospitalization. He was found to have a high-grade large-bowel obstruction with a dilated colon of 20 cm measuring upward. The patient ultimately underwent a hemicolectomy to prevent bowel ischemia and reformation of another volvulus. We present this case to elucidate the need for vigilant monitoring in patients with chronic bowel obstruction due to lack of typical symptoms, to demonstrate a successful management approach, and to exhibit an extreme example of the resulting megacolon.

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“…Many of those risk factors are modifiable ( 68 ). The concept of pre-operative optimization has evolved to describe clinical pathways that address a range of modifiable risk factors prior to surgery.…”

Section: Pre-operative Optimization Of the Patientmentioning

confidence: 99%

“…Surgery for penetrating CD is associated with higher morbidity than non-penetrating disease ( 97 ). The surgery may be technically challenging and require careful decision making ( 68 ).…”

Section: Surgery For Penetrating Crohn's Diseasementioning

confidence: 99%

Surgical Planning in Penetrating Abdominal Crohn's Disease

2022

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Crohn's disease (CD) is increasing globally, and the disease location and behavior are changing toward more colonic as well as inflammatory behavior. Surgery was previously mainly performed due to ileal/ileocaecal location and stricturing behavior, why many anticipate the surgical load to decrease. There are, however, the same time data showing an increasing complexity among patients at the time of surgery with an increasing number of patients with the abdominal perforating disease, induced by the disease itself, at the time of surgery and thus a more complex surgery as well as the post-operative outcome. The other major cause of abdominal penetrating CD is secondary to surgical complications, e.g., anastomotic dehiscence or inadvertent enterotomies. To improve the care for patients with penetrating abdominal CD in general, and in the peri-operative phase in particular, the use of multidisciplinary team discussions is essential. In this study, we will try to give an overview of penetrating abdominal CD today and how this situation may be handled. Proper surgical planning will decrease the risk of surgically induced penetrating disease and improve the outcome when penetrating disease is already established. It is important to evaluate patients prior to surgery and optimize them with enteral nutrition (or parenteral if enteral nutrition is ineffective) and treat abdominal sepsis with drainage and antibiotics.

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WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

Cited by 40 publications

References 117 publications

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Non-toxic Megacolon Secondary to High-Grade Large-Bowel Obstruction

Surgical Planning in Penetrating Abdominal Crohn's Disease

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