Surgery for small bowel Crohn's disease: experience of a tertiary referral center

The study aims to evaluate the clinical presentation and surgical management of small bowel Crohn's disease (CD) at a tertiary referral center in the Kingdom of Saudi Arabia (KSA).

A retrospective review of the medical records of all patients with the diagnosis of small bowel CD from March 1999 up to December 2003. The records of 28 patients were reviewed for demographic data, clinical presentation, preoperative investigations, indications of surgery, surgical procedures, postoperative complications and follow-up. The final diagnosis of CD was based on paraffin section histopathology reports.

The mean age was 34 years, female to male ratio was 1:2.1. The medical treatment was offered to 22 patients in whom the diagnosis of CD was established after investigations or they were known to have CD before admission. Thirteen patients (46.4%) responded to medical treatment, whereas 15 patients (53.6%) required surgery. The indications for surgery were intestinal obstruction (seven patients), right iliac fossa mass lesion of uncertain nature (three patients), enterocutaneous fistula and pelvic collection (one patient), failure of medical treatment (two patients), and acute abdomen (two patients). The surgical procedures carried out were limited right hemicolectomy in ten patients, segmental bowel resection (two patients) and stricturoplasty of the stenosed segment (three patients).

Crohn's disease is not uncommon in KSA. It is a disease of young patients, half of patients needed surgery at some stage. Intestinal obstruction remains the most common indication of surgery. The surgery of CD needs a good cooperation between the surgeon, radiologist and gastroenterologist.