Perforating Crohn's ileitis: delay of surgery is associated with inferior postoperative outcome.
BACKGROUND
A perforating phenotype is associated with an increased postoperative morbidity in patients with Crohn's disease undergoing ileocolic resection. Sequential conservative treatment attempts applied to patients with unrecognized perforating complications may lead to a delay of surgery and a further increase in morbidity.


METHODS
In all, 197 patients underwent 231 bowel resections for perforating ileitis between 1992 and 2009. The duration or clinical deterioration was calculated from the onset of clinical exacerbation unresponsive to any medical treatment to the date of surgery.


RESULTS
The median duration of clinical deterioration leading to surgery was 5 months. Patients with preoperative exacerbation lasting for >5 months had a higher number of structures involved in the inflammatory mass (3.3 versus 2.8 structures, P = 0.013), and had a higher probability to take immunosuppressive drugs (26% versus 14%, P = 0.042), budesonide (29% versus 14%, P = 0.009), and a multiple-drug combination (31% versus 16%, P = 0.015) at the time of surgery. Patients with symptoms lasting >5 months prior to surgery had a higher incidence of postoperative septic complications (31% versus 13%, P = 0.002), both by univariate and multivariate analysis. There was a significant increase in duration of preoperative clinical deterioration, size of the inflammatory mass, incidence of preoperative weight loss, intake of immunosuppressants and multiple-drug combination, and postoperative morbidity during the last 5 years of the study.


CONCLUSIONS
Delay of surgery in patients presenting with symptoms attributable to perforating ileitis is associated with an increased postoperative risk.
Iesalnieks
Igors
I
Department of Surgery, University of Regensburg, Germany. iesalnieks_igors@hotmail.com
Kilger
Alexandra
A
Glass
Heidi
H
Obermeier
Florian
F
Agha
Ayman
A
Schlitt
Hans J
HJ
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007079:Ileitis / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult