Diffuse small bowel Crohn's disease treated with side-to-side isoperistaltic strictureplasty: report of two cases and description of a variation of the original technique.
Diffuse small bowel Crohn's disease is unusual and it is characterized by multiple diseased segments involving the jejunum and ileum. The most frequent indication for surgery is an intestinal obstruction, often complicated by a high grade of malnutrition. The natural history of this clinical form is not well defined and the optimal surgical approach remains controversial. We herein present our surgical policy in two cases of diffuse small bowel Crohn's disease, who were particularly at risk of developing short bowel syndrome. We focused our attention on the use of side-to-side isoperistaltic strictureplasty as described by Michelassi for the treatment of stenoses longer than 20 cm. We also propose the application of this technique for the treatment of shorter stenosis cases.
Department of Surgical and Gastroenterological Sciences, First Surgical Clinic, School of Medicine, University of Padova, Via Giustiniani 2, 35100 Padova, Italy.
Antonio
A
Sommariva
Imerio
I
Angriman
Cesare
C
Ruffolo
Michela
M
Barollo
Davide Francesco
DF
D'Amico
D000328:Adult; D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000473:pathology / Q000601:surgery; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology / Q000601:surgery*; D007415:Intestinal Obstruction / Q000601:surgery; D007583:Jejunum / Q000473:pathology / Q000601:surgery*; D008297:Male; D012307:Risk Factors; D012778:Short Bowel Syndrome / Q000517:prevention & control*