Intestinal stenosis and perforating complications in Crohn's disease

The charts of 384 patients with Crohn's disease were reviewed to assess the prognostic value of a bowel stenosis documented at the time of initial diagnosis for the occurrence of perforating (abscess, fistula, free perforation) or obstructing complications requiring surgical intervention. Mean follow-up was 5.6 years. At time of diagnosis a bowel stenosis (S) was documented in 143 patients (37.2%). 130 patients underwent surgery, 62 (48%) for obstruction, 18 (14%) for a perforating complication, 12 (9%) for both obstructing and perforating complication and 38 (29%) for intractable disease. The cumulative rates of surgery were calculated using lifetable analysis. The presence of a stenosis at the time of initial diagnosis was a risk factor for the likelihood of surgery overall [65% (S) vs. 40% (no S) after 10 years; P < 0.001] and of surgery for obstruction [70% (S) vs. 34% (no S); P < 0.001] but did not increase the likelihood of a perforating complication [24% (S) vs. 29% (no S); n.s.]. A perforating complication requiring surgery may therefore not be predicted by the mere diagnosis of a stenosis. Prophylactic surgery of stenotic lesions in patients with Crohn's disease to prevent the development of a perforating complication therefore is not recommended.