Intestinal stenosis and perforating complications in Crohn's disease.
The charts of 384 patients with Crohn's disease were reviewed to assess the prognostic value of a bowel stenosis documented at the time of initial diagnosis for the occurrence of perforating (abscess, fistula, free perforation) or obstructing complications requiring surgical intervention. Mean follow-up was 5.6 years. At time of diagnosis a bowel stenosis (S) was documented in 143 patients (37.2%). 130 patients underwent surgery, 62 (48%) for obstruction, 18 (14%) for a perforating complication, 12 (9%) for both obstructing and perforating complication and 38 (29%) for intractable disease. The cumulative rates of surgery were calculated using lifetable analysis. The presence of a stenosis at the time of initial diagnosis was a risk factor for the likelihood of surgery overall [65% (S) vs. 40% (no S) after 10 years; P < 0.001] and of surgery for obstruction [70% (S) vs. 34% (no S); P < 0.001] but did not increase the likelihood of a perforating complication [24% (S) vs. 29% (no S); n.s.]. A perforating complication requiring surgery may therefore not be predicted by the mere diagnosis of a stenosis. Prophylactic surgery of stenotic lesions in patients with Crohn's disease to prevent the development of a perforating complication therefore is not recommended.
Makowiec
F
F
Department of General Surgery, University of Tübingen, Germany.
Jehle
E C
EC
Köveker
G
G
Becker
H D
HD
Starlinger
M
M
D000328:Adult; D003108:Colonic Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D003424:Crohn Disease / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007421:Intestine, Small; D008297:Male; D011379:Prognosis; D012307:Risk Factors