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Crohn's disease in the elderly.

G Tchirkow, I C Lavery, V W Fazio

    Diseases of the Colon and Rectum
    |March 1, 1983
    PubMed
    Summary

    Elderly patients (65+) with Crohn's disease (CD) showed good outcomes with ileal resection for small-bowel CD. Large-bowel CD required colectomy, with some needing further surgery for rectal symptoms.

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    Area of Science:

    • Gastroenterology
    • Colorectal Surgery
    • Geriatric Medicine

    Background:

    • Crohn's disease (CD) can affect the entire gastrointestinal tract, including the small intestine, colon, and rectum.
    • Surgical management in elderly patients (65 years and older) presents unique challenges due to comorbidities and altered physiological responses.

    Purpose of the Study:

    • To evaluate surgical outcomes for Crohn's disease in elderly patients.
    • To compare the efficacy of different surgical approaches based on disease location (small bowel vs. large bowel).

    Main Methods:

    • Retrospective analysis of 25 patients aged 65 and older undergoing surgery for Crohn's disease.
    • Surgical procedures included ileal resection with primary anastomosis, subtotal abdominal colectomy with end ileostomy, and one-stage proctocolectomy.

    Main Results:

    • Ileal resection and primary anastomosis yielded uniformly good results in elderly patients with predominantly small-bowel Crohn's disease.
    • Subtotal abdominal colectomy with end ileostomy improved health and facilitated weight gain in patients with large-bowel disease, though three required subsequent proctosigmoidectomy.
    • One-stage proctocolectomy in four patients resulted in one postoperative death and delayed perineal wound healing in survivors.
    • Elderly patients undergoing surgery for presumed sigmoid diverticulitis often had unrecognized colonic Crohn's disease, leading to frequent major complications.

    Conclusions:

    • Surgical approach for Crohn's disease in the elderly should be tailored to the specific location of the disease.
    • Ileal resection with primary anastomosis is a safe and effective option for elderly patients with small-bowel Crohn's disease.
    • Management of large-bowel Crohn's disease in the elderly may necessitate staged procedures to mitigate complications, particularly concerning rectal involvement.

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