Colonic Crohn's Disease

ABSTRACT

Crohn's disease is an inflammatory disease of the gastrointestinal (GI) tract of uncertain etiology. It can affect any portion of the GI tract, involving the colon in ~60% of cases. Diagnosis can be unclear, but suspicion can be raised based upon clinical, endoscopic, and pathologic findings. Initial management is often medical, with surgery reserved for patients with colonic complications of Crohn's disease, such as hemorrhage, fulminant colitis, abscess or fistula, stricture, and malignant transformation. The operative choice and conduct depends upon the clinical presentation and intraoperative findings. The extent of resection is controversial, but segmental resection is appropriate in selected cases.

KEYWORDS

Crohn's disease - colon - colitis - surgery

REFERENCES

• 1 Tanaka M, Riddell R H. The pathological diagnosis and differential diagnosis of Crohn's disease.  Hepatogastroenterology. 1990;  37(1) 18-31
• 2 Robert J R, Sachar D B, Greenstein A J. Severe gastrointestinal hemorrhage in Crohn's disease.  Ann Surg. 1991;  213(3) 207-211
• 3 Driver C P, Anderson D N, Keenan R A. Massive intestinal bleeding in association with Crohn's disease.  J R Coll Surg Edinb. 1996;  41(3) 152-154
• 4 Belaiche J, Louis E, D'Haens G et al.. Acute lower gastrointestinal bleeding in Crohn's disease: characteristics of a unique series of 34 patients.  Am J Gastroenterol. 1999;  94(8) 2177-2181
• 5 Greenstein A J, Sachar D B, Gibas A et al.. Outcome of toxic dilatation in ulcerative and Crohn's colitis.  J Clin Gastroenterol. 1985;  7(2) 137-143
• 6 Swan N C, Geoghegan J G, O'Donoghue D P, Hyland J MP, Sheahan K. Fulminant colitis in inflammatory bowel disease.  Dis Colon Rectum. 1998;  41(12) 1511-1515
• 7 Cheung O, Regueiro M D. Inflammatory bowel disease emergencies.  Gastroenterol Clin North Am. 2003;  32(4) 1269-1288
• 8 Roy M A. Inflammatory bowel disease.  Surg Clin North Am. 1997;  77 1419-1431
• 9 Turnbull RB Jr, Hawk W A, Weakley F L. Surgical treatment of toxic megacolon. Ileostomy and colostomy to prepare patients for colectomy.  Am J Surg. 1971;  122(3) 325-331
• 10 Ooi B S, Remzi F H, Fazio V W. Turnbull-Blowhole colostomy for toxic ulcerative colitis in pregnancy: report of two cases.  Dis Colon Rectum. 2003;  46(1) 111-115
• 11 Zelas P, Jagelman D G. Loop ileostomy in the management of Crohn's colitis in the debilitated patient.  Ann Surg. 1980;  191(2) 164-168
• 12 Winslet M C, Andrews H, Allan R N, Keighley M RB. Fecal diversion in the management of Crohn's disease of the colon.  Dis Colon Rectum. 1993;  36(8) 757-762
• 13 Trickett J P, Tilney H S, Gudgeon A M, Mellor S G, Edwards D P. Management of the rectal stump after emergency sub-total colectomy: which surgical option is associated with the lowest morbidity?.  Colorectal Dis. 2005;  7(5) 519-522
• 14 Cattan P, Bonhomme N, Panis Y et al.. Fate of the rectum in patients undergoing total colectomy for Crohn's disease.  Br J Surg. 2002;  89(4) 454-459
• 15 Ikeuchi H, Yamamura T. Free perforation in Crohn's disease: review of the Japanese literature.  J Gastroenterol. 2002;  37(12) 1020-1027
• 16 Gutierrez A, Lee H, Sands B E. Outcome of surgical versus percutaneous drainage of abdominal and pelvic abscesses in Crohn's disease.  Am J Gastroenterol. 2006;  101(10) 2283-2289
• 17 Saint-Marc O, Vaillant J C, Frileux P, Balladur P, Tiret E, Parc R. Surgical management of ileosigmoid fistulas in Crohn's disease: role of preoperative colonoscopy.  Dis Colon Rectum. 1995;  38(10) 1084-1087
• 18 Yamazaki Y, Ribeiro M B, Sachar D B, Aufses A H, Greenstein A J. Malignant colorectal strictures in Crohn's disease.  Am J Gastroenterol. 1991;  86(7) 882-885
• 19 Maykel J A, Hagerman G, Mellgren A F et al.. Crohn's colitis: the incidence of dysplasia and adenocarcinoma in surgical patients.  Dis Colon Rectum. 2006;  49(7) 950-957
• 20 Nomura E, Takagi S, Kikuchi T et al.. Efficacy and safety of endoscopic balloon dilation for Crohn's strictures.  Dis Colon Rectum. 2006;  49(10 Suppl) S59-S67
• 21 Fireman Z, Grossman A, Lilos P et al.. Intestinal cancer in patients with Crohn's disease. A population study in central Israel.  Scand J Gastroenterol. 1989;  24(3) 346-350
• 22 Persson P G, Karlen P, Bernell O et al.. Crohn's disease and cancer: a population-based cohort study.  Gastroenterology. 1994;  107(6) 1675-1679
• 23 Ekbom A, Helmick C, Zack M, Adami H O. Increased risk of large-bowel cancer in Crohn's disease with colonic involvement.  Lancet. 1990;  336(8711) 357-359
• 24 Gillen C D, Andrews H A, Prior P, Allan R N. Crohn's disease and colorectal cancer.  Gut. 1994;  35(5) 651-655
• 25 Friedman S, Rubin P H, Bodian C, Goldstein E, Harpaz N, Present D. Screening and surveillance colonoscopy in chronic Crohn's colitis.  Gastroenterology. 2001;  120(4) 820-826
• 26 Pennington L, Hamilton S R, Bayless T M, Cameron J L. Surgical management of Crohn's disease. Influence of disease at margin of resection.  Ann Surg. 1980;  192(3) 311-318
• 27 Heuman R, Boeryd B, Bolin T, Sjodahl R. The influence of disease at the margin of resection on the outcome of Crohn's disease.  Br J Surg. 1983;  70(9) 519-521
• 28 McLeod R S. Resection margins and recurrent Crohn's disease.  Hepatogastroenterology. 1990;  37(1) 63-66
• 29 Kotanagi H, Kramer K, Fazio V W, Petras R E. Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn's disease? Retrospective analysis of 100 cases.  Dis Colon Rectum. 1991;  34(10) 909-916
• 30 Fazio V W, Marchetti F, Church M et al.. Effect of resection margins on the recurrence of Crohn's disease in the small bowel. A randomized controlled trial.  Ann Surg. 1996;  224(4) 563-571
• 31 Longo W E, Ballantyne G H, Cahow C E. Treatment of Crohn's colitis. Segmental or total colectomy?.  Arch Surg. 1988;  123(5) 588-590
• 32 Fichera A, McCormack R, Rubin M A, Hurst R D, Michelassi F. Long-term outcome of surgically treated Crohn's colitis: a prospective study.  Dis Colon Rectum. 2005;  48(5) 963-969
• 33 Andersson P, Olaison G, Hallbook O, Sjodahl R. Segmental resection or subtotal colectomy in Crohn's colitis?.  Dis Colon Rectum. 2002;  45(1) 47-53