Keywords:
Gastrointestinal tract, CT, Contrast agent-oral, Endoscopy, Barium enema
Authors:
F. Paparo, M. Revelli, C. Puppo, I. Garello, L. Bacigalupo, L.-P. Rollandi, R. Piccazzo, A. Garlaschi, G. A. Rollandi; Genoa/IT
DOI:
10.1594/ecr2013/B-0197
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 anastomoses) has been proposed as a potential risk factor,
but results on this issue are controversial [4-6].
Some Authors suggest that wide-lumen stapled end-to-end technique may reduce the risk of obstruction of the anastomosis because of a wider anastomotic lumen [6].
The neoterminal ileum is the most frequent site of CD recurrence,
but the prevalence of recurrent inflammatory lesions in other gastrointestinal segments distinct from the ileocolic anastomosis has received little attention.
Currently,
optical colonoscopy with retrograde ileoscopy represents the gold standard technique for the assessment of anastomotic recurrence after surgery,
but the procedure is invasive and carries the risk of colonic perforation.
Moreover,
anastomotic stenosis can hinder the progression of the endoscope such that a complete evaluation of the anastomotic site,
including the neoterminal ileum,
is not possible in up to one-third of patients [7].
To overcome the limitations of endoscopy,
different non-invasive radiological techniques have been employed to evaluate the postoperative recurrence of CD,
including small bowel enteroclysis and small bowel follow-through [8],
small intestine contrast ultrasonography (SICUS) [9],
CT-enteroclysis and enterography [10,
11] and MR-enteroclysis [12].
CT-enterography with water enema (CTe-WE) [13] is an original CT technique which can produce an effective simultaneous distension of both small and large bowel,
providing a complete phenotypic characterization of CD,
including disease distribution,
behavior and extraintestinal manifestations.
Our retrospective study had three main objectives: the primary objective was to determine the diagnostic value of CTe-WE in the evaluation of the surgical anastomosis in CD patients who had previously undergone ileocolic resection; the second objective was to determine the prevalence of synchronous inflammatory lesions (SILs) involving gastrointestinal segments distinct from the anastomotic site; the third objective was to verify the presence of a significant association between the type of ileocolic anastomosis (i.e.
side-to-side,
end-to-side or end-to-end) and the behavior of CD recurrence (i.e.
inflammatory,
stricturing,
penetrating).