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[Emergency surgery in inflammatory bowel disease. Experience in 26 cases].

Abstract：

BACKGROUND:The emergency surgical treatment of inflammatory chronic bowel diseases is closely related to the classification of patients according to their symptoms and clinical conditions, as well as possible surgical options. In our study, an actual set of criteria is proposed for the classification of the degree of seriousness of symptoms, related to patient conditions, and applicable surgical strategies. METHODS:Retrospectively evaluation of the outcome of the disease has been performed over 26 patients undergoing emergency treatment in our Hospital, and with at least 5 years of follow-up. Fourteen patients were affected by ulcerative rectocolitis and 11 underwent subtotal colectomy with ileostomy; the remaining 12 were affected by Crohn's disease and were treated with colic or ileal local resection. RESULTS:Among 11 operated patients with RCU, 6 toxic megacolon, 4 severe colitis and one perforation (postoperative death) have been diagnosed. Recanalization was possible in 8 patients. On the other hand proctectomy was necessary in the remaining 3 patients as final operation. In MC patients 6 occlusions, 4 severe colitis, one multiple perineal fistulization and one perforation of occult right colon tumor have been diagnosed. We performed 5 right colectomy, 4 jejuno-ileal resections, one Hartmann's operation, one colostomy in emergency and one multiple bypass. Because of recurrence, one right colectomy needed following total colectomy and two jejuno-ileal resections needed right colectomy soon after. Three jejuno-ileal resections were performed with a conservative purpose in patients treated by right colectomy. CONCLUSIONS:It has resulted that in ulcerative rectocolitis total colectomy actually permits an adequate control of the disease, as well as a satisfactory therapy of the rectal stump, with subsequent recanalization in the majority of cases, whereas in Crohn's disease the frequency of recidive is higher and it seems more advisable to opt for a radical resection treatment (chiefly right colectomy), but with a conservative purpose.

journal_name

Minerva Chir

journal_title

Minerva chirurgica

authors

D'Addazio G,Scordamaglia R,Tedeschi U,Barra M,Arpe F,Beatini L,Meola V

keywords:

subject

Has Abstract

pub_date

1998-12-01 00:00:00

pages

1001-7

issue

eissn

0026-4733

issn

1827-1626

journal_volume

pub_type

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[Emergency surgery in inflammatory bowel disease. Experience in 26 cases].