Surgical management of Crohn's disease: experience with 135 patients

Crohn's disease may involve any portion of the alimentary tract and is being seen with increasing frequency. This report details the results in 135 patients undergoing 214 operations for Crohn's disease. There were 68 males and 67 females ranging in age from 10 to 76 years. Thirty-two per cent of patients underwent multiple operations. The recurrence rate was 53 per cent, with an average follow-up of four years. The common sites of involvement by Crohn's disease were ileocolic (36%), ileum (31%), and perianal (16%). Patients were also managed for Crohn's disease of the esophagus, stomach, and duodenum. Our patient patient with Crohn's disease of the esophagus is very unique, as only 20 such cases have been reported. Primary resection of diseased bowel with re-anastomosis is the preferred operative management. A bypass procedure was done in only four patients. The mortality rate was 2.2 per cent. The incidence of carcinoma is increased in patients with small bowel regional enteritis. A recent literature review reports 36 patients with adenocarcinoma of the small bowel affected with regional enteritis. Three of the patients developed an adenocarcinoma in association with Crohn's disease.