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Can Crohn's disease be diagnosed at laparotomy?
R J Butterworth1, G T Williams, L E Hughes
1University Department of Surgery, University Hospital of Wales, Heath Park, Cardiff.
Gut
|January 1, 1992
Summary
Macroscopically normal small bowel on laparotomy does not exclude Crohn's disease. Patients with persistent symptoms after a negative laparotomy require further investigation for this inflammatory bowel disease.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Crohn's disease diagnosis typically relies on macroscopic features identified during laparotomy.
- Radiological evidence often supports symptomatic Crohn's disease prior to surgical intervention.
Observation:
- Six patients with radiologically confirmed symptomatic Crohn's disease presented with macroscopically normal small bowel during laparotomy.
- Despite experienced surgical examination, the disease was not macroscopically evident in the small bowel in four cases, leading to deferred resection.
- Minor terminal ileum abnormalities detected via balloon examination prompted resection in two patients.
Findings:
- Histological examination revealed a superficial distribution of inflammation, potentially explaining the negative macroscopic findings during surgery.
- Deferred resection in four patients resulted in subsequent clinical deterioration and the need for further surgical intervention.
Implications:
- Macroscopic findings during laparotomy alone are insufficient to rule out clinically significant small bowel Crohn's disease.
- Persistent symptoms post-negative laparotomy warrant consideration of Crohn's disease and further diagnostic evaluation.