Purpose
Ileocolic resection with ileocolic anastomosis may be necessary in Crohn's disease (CD) patients that do not respond to conservative medical treatment.
Postoperative recurrence is a feature of CD,
which is observed in up to 70% of cases [1].
Several factors have been advocated as predictors of early symptomatic CD anastomotic recurrence,
in particular the distribution of inflammatory lesions (CD location) prior to surgery,
disease behavior (i.e.
inflammatory,
stricturing,
penetrating [2]),
and patient’s smoking status [3].
The type of ileocolic anastomosis (stapled side-to-side vs hand-sewn end-to-end...
Methods and Materials
This was a retrospective,
single-center,
institutional review board approved study.
CD patients treated by ileocolic resection and ileocolic anastomosis were identified by performing a search in our single-institution radiology database for the association of the keywords "Crohn's disease" and "anastomotic recurrence" in all CTe-WE examinations from January 2007 through December 2011.
A total of 75 CTe-WEs were obtained,
and if one of the selected patients underwent more than one CTe-WE,
only the more recent examination was considered for further evaluation,
thus resulting in 51 CTe-WEs...
Results
51 patients were included (26 [51%] male and 25 [49%] female; mean age: 52.88 years ± 13.35; age range: 32–79 years).
The mean CD duration in our study cohort was 11.6 ± 6.2 years,
with a mean time interval between age of symptom onset and ileocolic resection of 7.2 ± 4.5 years.
Ileocolic anastomoses were as follows: 18 (35.3%) stapled side-to-side,
17 (33.3%) end-to-side (7 stapled and 10 hand-sewn),
and 16 (31.4%) end-to-end (6 stapled and 10 hand-sewn).
The clinical indication for the CTe-WE was...
Conclusion
Currently ileocolonoscopy remains the gold standard technique to evaluate CD recurrence in patients who have undergone ileocolic resection.
Nevertheless,
endoscopy is an invasive method that frequently needs patient's sedation or anaesthesia.
In addition,
it may also be incomplete due to modified anatomy and luminal narrowing in correspondence to the anastomotic site,
preventing the progression of the endoscope in approximately one-third of cases [3,
9].
In such situations,
endoscopy allows for an evaluation limited to the colonic side of the anastomosis.
On the other hand,
the...
References
[1] Ng SC,
Kamm MA. Management of postoperative Crohn's disease.
Am J Gastroenterol 2008; 103(4):1029-35.
[2] Satsangi J,
Silverberg MS,
Vermeire S,
Colombel JF. The Montreal classification of inflammatory bowel disease: controversies,
consensus,
and implications.
Gut 2006; 55(6):749-53.
[3] Yamamoto T.
Factors affecting recurrence after surgery for Crohn's disease.
World J Gastroenterol 2005; 11(26):3971-9.
[4] Tersigni R,
Alessandroni L,
Barreca M,
et al.
Does stapled functional end-to-end anastomosis affect recurrence of Crohn's disease after ileocolonic resection?.
Hepatogastroenterology 2003; 50(53):1422-5.
[5] McLeod RS,
Wolff BG,
Ross...