Z Gastroenterol 2006; 44 - A112
DOI: 10.1055/s-2006-943478

Elective laparascopic resection of stenotic lesion of the colon in Crohn's disease (case report)

R Schwab 1, O Szokolóczi 1, B Tihanyi 2, R Vernes 1, A Papp 2, G Fodor 1, M Burai 1, Á Pap 1, T Tihanyi 2
  • 1Depts. Medicine and Gastroenterology, Kelen Hospital
  • 21st Department of Surgery, Semmelweis University, Budapest, Hungary

Background: The incidence of acute, therapy resistant Crohn's disease as an indication of surgery has constantly been decreasing since introduction of anti-TNF biologics. However, surgery is still warranted for patients in remission with strictures and fibrotic stenosis without apparent clinical symptoms. These lesions may contribute to disease fare-ups as well as present considerable risk concerning long term management.

Our patient: is a 47 year-old male subject with a 27 years' history of Crohn's Disease. Long term management in different institutions has been based on 5ASA therapy, without standard immunosuppressive care. His symptoms have been on and off without major morbidity, however, stricture of the transverse colon has been known for the past 20 years. The patient was referred to our out-patient clinic in sep. 2005 with disease flare-up, elevated CRP, ESR and clinical signs of subileus. In parallel to maintaining daily stools by osmotic laxatives and personalized diet 1mg/bw methylprednisone (with 4mg weekly tapering) and 1.5mg/bw azathioprine were introduced. Acute inflammatory symptoms cleared within 3 months, and colonoscopy was undertaken to check for permanent pathology and screen for colorectal cancer. Fibrotic stricture of the transverse colon was confirmed, which could not be passed with the endoscope and the patient was referred to surgery.

After vigorous preoperative planning incl. CT, US, etc. the resection was undertaken by laparoscopy. Following insufflation the omentum was turned up and the affected bowel segment mobilized at the hepatic flexture. Adhesions were cleared and the colon was pulled out through a RINK folie in a right subcostal incision and resected with extracorporeal end-to-end anastomosis. The patient was discharged in the 5th postoperative day and is well off after 2.5 months follow-up.

Discussion: Surgical management should be reserved for long term complications of Crohn's disease. Optimally this is performed in full remission. Laparoscopic resection is an emerging option to ensure minimal invasiveness, quick recovery in carefully selected cases.