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[Complications of Crohn disease, surgical indications, surgical solutions and recurrence]
Insights
Crohn's disease frequently causes serious complications like intestinal obstruction and fistulas. Surgical intervention is often necessary, but recurrence rates remain high, leading to uncertain long-term prognoses.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease Research
Context:
- Crohn's disease is characterized by frequent and diverse complications.
- Intestinal obstruction and fistulas are common complications arising from inflammatory granulomas.
- The incidence of complications correlates with disease duration.
Purpose:
- To summarize the common complications of Crohn's disease.
- To outline the indications for surgical versus medical management of Crohn's disease complications.
- To present data on surgical outcomes and recurrence rates in Crohn's disease.
Summary:
- Common complications include intestinal obstruction due to strictures and angulation, as well as fistulas involving various organs.
- Surgical intervention is indicated for life-threatening complications or when medical treatment is insufficient, with intestinal resection and strictureplasty being common procedures.
- Operative mortality is 4.1%, and recurrence rates range from 28% to 33.3%, with a current operative mortality of 18.6%, highlighting the uncertain prognosis.
Impact:
- Provides a concise overview of Crohn's disease complications and management strategies.
- Highlights the significant morbidity and mortality associated with Crohn's disease complications.
- Emphasizes the chronic and recurrent nature of Crohn's disease, impacting long-term patient outcomes.
Abstract:
There is not another disease, of which complications would be such frequent and various as of Crohn's disease. One of the most common complications is intestinal obstruction, caused by angulation and stricture, as a result of inflammatory granulomas. Fistulas between affected intestines and cavital organs or the abdominal wall can also often be observed. The likelihood of appearing complications is correlating with the time from the onset of the disease. If they are dangerous for the patient's life, surgical intervention is required. In some of the cases, when complications don't threaten the patient's life, medical treatment may be beneficial. Surgery is indicated only in those cases, when complications mean danger, or the continuous active medical treatment is insufficient. Most frequently the resection of the damaged intestine is performed, nowadays stricture plasty is also recommended. The operative mortality is 4.1%. The disease is featured by frequent recurrences: 28% to 33.3%. The current operative mortality is 18.6%. The prognosis is always uncertain, because recurrence may occur many years after operation.