COMPARISON OF EMERGENCY SURGERY OF CROHN'S DISEASE IN PATIENTS WITH AND WITHOUT PRIOR DIAGNOSIS OF CROHN

Yıl 2022, , 19 - 24, 17.01.2022

Gürcan Şimşek , Mehmet Eşref Ulutaş , Alpaslan Şahin , Ethem Ömeroğlu , Kemal Arslan

https://doi.org/10.18229/kocatepetip.774805

Öz

OBJECTIVE: Although there are many new developments in the treatment of Crohn's disease (CD), the need for surgical treatment is required between 70% and 90% at various stages of the disease. Surgical treatment indications can be grouped under two main headings as complications and medical treatment insufficiency. This study was conducted to state the surgical treatment and results of our patients who were operated in emergency conditions due to CD in our clinic and to reveal the differences between with and without previous Crohn's diagnosis.
MATERIAL AND METHODS: The study was conducted retrospectively. Patients who were operated under emergency conditions in our clinic between January 2014 and December 2019 and who were pathologically diagnosed with CD were included. Demographic data of all patients, whether there is a previous CD diagnosis, previously diagnosed of CD patients's duration disease time and medical treatments used were recorded. Later, those with and without the diagnosed of CD were divided into two groups. Admission symptoms, indications for surgical treatment, disease involvement, surgical treatment and accompanying malignancy of all patients were recorded and these two groups were compared. A P <0.05 was considered significant.
RESULTS: 22 patients were included in the study. 14 of the patients were female (59.1%) and 8 of them were male (40.9%). The mean age was 39.23 ± 18.48. 7 (31.8%) of the patients had a previous diagnosis of CD. The most common (86%) presenting symptom was abdominal pain. The most common emergency surgical procedure was right hemicolectomy. (30.5%) Among the two groups compared; There was no statistically significant difference between admission symptoms, involvement locations, preoperative diagnoses, stoma rate, stomata time and accompanying malignancy rates (p> 0.05).
CONCLUSIONS: The most common emergency surgical treatment indication in CH is obstruction. The frequency of perforation was found to be more frequent than the literature. (18.1%) The fact that patients were diagnosed with CD before the operation increases the frequency of stoma in treatment, but statistically, no difference was found. Knowing the preoperative diagnosis of CD in patients operated on due to complications seems to affect surgical treatment.

Anahtar Kelimeler

Crohn, Complication, Emergency surgery

CROHN HASTALIĞININ ACİL CERRAHİ TEDAVİSİNDE ÖNCEDEN CROHN HASTALIĞI TANISI OLAN VE OLMAYAN HASTALARIN KARŞILAŞTIRILMASI

Öz

AMAÇ: Crohn hastalığının (CH) tedavisinde birçok yeni gelişme olmasına karşın cerrahi tedavi gereksinimi hastalığın çeşitli dönemlerinde %70-90 arasındadır. Cerrahi tedavi endikasyonları komplikasyonlar ve medikal tedavi yetersizliği olmak üzere iki ana başlıkta toplanabilir. Bu çalışma; kliniğimizde CH nedeni ile acil şartlarda opere edilen hastalarımızın cerrahi tedavilerini, sonuçlarını belirtmek ve preop CH tanısı olan ve olmayan vakalar arasındaki farkları ortaya koymak amacı ile yapılmıştır.
GEREÇ VE YÖNTEM: Çalışma retrospektif olarak yapıldı. Kliniğimizde Ocak 2014 ve Aralık 2019 tarihleri arasında acil şartlarda opere edilen ve patolojik olarak CH tanısı olan hastalar dahil edildi. Hastaların demografik verileri, preop dönemde CH tanısı alıp almadıkları, CH tanısı varsa; süresi ve kullanılan medikal tedaviler kaydedildi. Daha sonra preop CH tanısı olan ve olmayanlar iki gruba ayrıldı. Tüm hastaların; başvuru semptomları, cerrahi tedavi endikasyonları, hastalığın tutulum yeri, uygulanan cerrahi tedavi ve eşlik eden malignite durumları kaydedildi ve bu iki grup karşılaştırıldı. P<0,05 olması anlamlı kabul edildi.
BULGULAR: Çalışmaya 22 hasta dahil edildi. Hastaların 14’ü kadın (%59,1) ve 8’i erkekti (%40,9). Ortalama yaş 39.23±18.48'di. Hastalardan 7’sinin (%31,8) preop dönemde CH tanısı vardı. En sık (%86) başvuru semptomu karın ağrısıydı. En sık uygulanan acil cerrahi prosedür sağ hemikolektomiydi.(% 30,5) Karşılaştırılan 2 grup arasında ; başvuru semptomları, tutulum yerleri, preop ön tanılar, stoma oranı ve stoma kalma zamanları ile eşlik eden malignite oranları arasında istatistiksel olarak anlamlı fark tespit edilmedi (p>0,05).
SONUÇ: CH’ da en sık acil cerrahi tedavi endikasyonu obstrüksiyondur. Perforasyon sıklığı literatüre göre daha sık bulunmuştur.(%18,1) Hastaların operasyon öncesi CH tanısının olması tedavide stoma sıklığını arttırmaktadır ancak istatistiksel olarak fark tespit edilememiştir. Komplikasyon nedeniyle ameliyat edilen hastalarda preoperatif dönemde CH tanısının bilinmesi cerrahi tedaviyi etkilemekte gibi görünmektedir.

Anahtar Kelimeler

Acil cerrahi, Crohn Hastalığı, Komplikasyon, Acil cerrahi

Kaynakça

• 1. Bernstein CN, Loftus EV, Ng SC, et al. Hospitalisations and surgery in Crohn’s disease. Gut. 2012;61(4):622-9.
• 2. Bouguen G, Biroulet LP. Surgery for adult Crohn’s disease: what is the actual risk? Gut. 2011;60(9):1178-81. 3. Rungoe C, Langholz E, Andersson M, et al. Changes in medical treatment and surgery rates in inflammatory bowel disease: a nation wide cohort study Gut. 1979–2011. 2014;63(10):1607-16.
• 4. Hwang JM, Varma MG. Surgery for inflammatory bowel disease. World J Gastroenterol. 2008(7);14(17): 2678-2690.
• 5. Frolkis AD, Dykeman J, Negron ME, et al. Risk of Surgery for Inflammatory Bowel Diseases Has Decreased Over Time: A Systematic Review and Meta-analysis of Population- Based Studies. Gastroenterology. 2013;145(5):996-1006.
• 6. Maartense S, Dunker MS, Slors JF, et al. Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial. Ann Surg. 2006;243(2):143-9; 150-3.
• 7. Muldoon R, Herline AJ. Crohn’s disease: surgical management. Steele SR, Hull TL, Read TE et al (editors). The ASCRS textbook of colon and rectal surgery. 3rd edition. New York: Springer International Publishing. 2016: 843–68.
• 8. Alos R, Hinojosa J. Timing of surgery in Crohn’s disease: a key issue in the management. World J Gastroenterol. 2008;14(36):5532–9.
• 9. Berg DF, Bahadursingh AM, Kaminski DL, et al. Acute surgical emergencies in inflammatory bowel disease. Am J Surg. 2002;184(1):45–51.
• 10. Bessissow T, Reinglas J, Aruljothy A et al. Endoscopic management of Crohn’s strictures. World J Gastroenterol. 2018;24(17):1859–67.
• 11. Yamazaki Y, Ribeiro MB, Sachar DB et al. Malignant strictures in Crohn’s disease. Am J Gastroenterol. 1991;86(7):882-5.
• 12. Bundred NJ, Dixon JM, Lumsden AB et al. Free perforation in Crohn’s colitis: a ten year review. Dis Colon Rectum. 1985;28(1):35-7.
• 13. Nordlinger B, Saint-Marc O. Free perforation. Michelassi F, Milsom JW (editors). Operative strategies in inflammatory bowel disease. New York:Springer-Verlag, 1999; 369– 73.
• 14. Truong A, Zaghian K, Fleshner P. Anorectal Crohn's Disease.Surg Clin North Am. 2019;99(6):1151-1162.
• 15. Schwartz DA, Loftus EV, Tremaine WJ, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology. 2002;122(4): 875–80.
• 16. Zalieckas JM. Treatment of perianal Crohn’s disease. Semin Pediatr Surg. 2017; 26(6):391–7.
• 17. Jess T, Winther KV, Munkholm P, Langholz E, Binder V. Intestinal and extra-intestinal cancer in Crohn’s disease: follow-up of a population-based cohort in Copenhagen County, Denmark. Aliment Pharmacol Ther. 2004;19:287–293.
• 18. Greenstein A. Malignancy in Crohn’s disease. Perspect Colon Rectal Surg. 1995;8:137–159.
• 19. Lewis RT, Maron DJ. Efficacy and complications of surgery for Crohn’s disease. Gastroenterol Hepatol [N Y]. 2010;6:587–96.
• 20. Chardavoyne R, Flint GW, Pollack S, Wise L. Factors affecting recurrence following resection for Crohn’s disease. Dis Colon Rectum. 1986;29:495–502.
• 21. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg. 2000;231:38–45.