Malattia di Crohn colorettale: quando e come operare

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F. TONELLI, G.M. PAROLI

Ann. Ital. Chir., LXXIV, 6, 2003

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Colorectal Crohn’s Disease (CRCD) represents the 25% of
all cases of Crohn’s Disease (CD). Between January 1984
and December 2000 we have operated 68 patients with
CRCD, that represent 10,3% of the patients operated for
CD. Thirtythree patients (48,5%) were men and 35
(51,5%) were women. The median age at diagnosis was
37,3 ± 13,1 years, with the highest incidence during the
fourth decade.
In most cases the disease involved the left colon and rectum
(65,9%), while in 6,3% and in 3,8% of cases the
right and the transverse colon respectively. In the 27,9%
of cases the entire colon was involved.
At the time of surgery, the disease behaviour was stenosing
in 30,9% of patients, inflammatory in 22,1%, and penetrating
in 47% of cases with the presence of fistulae
(coloenteric in 6 patients, colo-bladder in 2 cases, rectouretral
in 1 case, colo-cutaneous in 4 cases and intramesenteric
in 2 cases) and abscesses (23,5% of patients). In
three patients the CRCD had led to neoplastic transformation.
Fourteen patients had undergone an emergency surgical procedure
for severe acute colitis, 2 for toxic megacolon, 1 for
an intraabdominal abscess and one for intestinal occlusion.
In the segmentary forms we have always practiced a resection
of the diseased colonic segment without total colectomy.
In the cases with diffuse colonic involvement in which
the rectum was free from disease a total colectomy with
ileorectal anastomosis was performed. In the cases with rectal
disease (26 cases) the sphinteric function was preserved
with low rectal resection or with colo-anal anastomosis. In
4 patients with rectal disease and in 4 cases with fistulae,
we complited the intervention with a permanent stoma.
During the median follow-up of 83,7 months (12-207)
the surgical relapse was of 27,3%.
We suggest to treat CRCD with resections limited to the
diseased segment. Moreover, it is possible to preserve the
sphinteric function every time the rectum or the anal canal
are normal, without postoperative complications or early
relapses.

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