Intestinal perforation in Crohn's disease. Factors predictive of surgical resection.
New medical therapeutic options challenge the usual surgical management of Crohn's disease patients with intestinal perforation.


OBJECTIVE
To determine factors predictive of surgery for perforation in Crohn's disease and define a group of patients that may benefit from non-surgical treatment.


METHODS
One hundred and sixty-two patients (69 males, 93 females, mean age 39) with perforated Crohn's disease (fistula, abscess, inflammatory mass) between January 1995 and September 2003 were studied retrospectively.


RESULTS
One hundred and fifty-one patients (93%) underwent surgery: 70 had planned surgery and 81 had surgery for symptomatic deterioration. At two years, the cumulative probability of intestinal resection was 0.89 +/- 0.03, and the cumulative probability of unplanned intestinal resection was 0.72 +/- 0.05. Predictive factors of unplanned surgery were elevated platelet count (adjusted hazard ratio 3.15; 95% CI 2.21-4.50) and absence of fistula (adjusted hazard ratio 3.14; 95% CI 2.48-3.99). The rate of postoperative complications, the need for a stoma, and the length of bowel resection were not significantly different whether the surgery was planned or not.


CONCLUSIONS
A significant proportion of patients with intestinal perforation complicating Crohn's disease, particularly those with a fistula, might benefit from non-surgical treatment.
Brihier
Hélène
H
Service de Gastroentérologie et Nutrition et Service de Chirurgie, Hôpital Saint-Antoine, Paris.
Nion-Larmurier
Isabelle
I
Afchain
Pauline
P
Tiret
Emmanuel
E
Beaugerie
Laurent
L
Gendre
Jean-Pierre
JP
Cosnes
Jacques
J
D000038:Abscess / Q000209:etiology / Q000601:surgery; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery*; D016154:Digestive System Fistula / Q000209:etiology* / Q000601:surgery; D013505:Digestive System Surgical Procedures; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors