ABDOMINOPERINEAL AMPUTATION DUE TO CROHN'S DISEASE: CASE SERIES

Introduction Crohn's Disease (CD) affects various regions of the gastrointestinal tract. The most challenging complications occur when CD affects the perianal region, which is associated with a reduced quality of life for the patient. Although there are different treatments, there is a significant risk of progression to irreversible anorectal fibrosis and consequent abdominoperineal amputation (AP), which can occur in up to 15% of cases.

Objective To analyze the prevalence and clinical-laboratory characteristics related to perianal CD in patients undergoing AP in a public tertiary hospital service, as well as to understand the postoperative evolution and complications of these patients.

Methods This is a retrospective study of data collected from medical records of patients who underwent AP between 2000 and 2024 due to perianal CD. The Chi-square test was used to analyze the heterogeneity of frequency distribution in the studied cohort.

Results In the analyzed period, considering all patients who underwent AP (n=479), it was observed that only 3.96% (19 patients) were due to Crohn's disease. Among them, the majority were female (63.2%), with a mean age of 39 ± 11.3 years and a mean BMI of 23.7 ± 5.1 when undergoing total proctectomy. The average time interval from diagnosis to amputation was 13.8 ± 6.7 years. Only one patient had never undergone surgery, and all others had previous perianal interventions, with fistulotomy (77.7%) being the most frequent. Of the total, 73.7% already had a prior ostomy. Only one death was associated with the procedure, and in 3 cases, malignancy was found in the surgical specimen. Comparatively, it was observed that the presence of anemia and hypoalbuminemia did not affect the complication rates. There was no statistical difference in complication rates in patients using corticosteroids (0% vs. 47.1%; p=0.48), azathioprine (33.3% vs. 43.8%; p=1.00), and immunobiologics (45.5% vs. 37.5%; p=1.00). Similarly, no differences were observed in patients who had been previously ostomized (42.9% vs. 40.0%; p=1.00).

Conclusion Despite therapeutic advances in CD, perianal involvement with consequent amputation remains an important outcome in the disease's progression. Although delayed by other therapeutic alternatives, it still occurs early and involves factors related to both the patient's prior history and postoperative factors, which were analyzed in this study.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025