Malattia di Crohn colorettale: quando e come operare



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.