Crohn’s disease in the elderly

Abstract

AIM OF THE STUDY: To define the characteristics of Crohn’s disease in the elderly, basing on our own and other Authors’ experience.

CASISTIC: During last 10 years, 46 patients affected by Crohn’s disease were observed at Emergency Surgery Unit of “Vittorio Emanuele” Hospital in Catania (Italy). Of these patients, 4 (8,6%) were old: 3 with an ileal location and 1 with a colic location of the disease. This latter patient was cured only by medical treatment because of the paucity of clinical manifestations of the disease. The other 3 patients underwent surgical treatment (2 ileocecal resections and 1 ileal resection).

RESULTS: Up to date all 4 patients are alive and in good general conditions. Only one patient had recurrence of disease, but recovered after medical treatment.

DISCUSSION: Crohn’s disease in the elderly, although usually similar to the adult form, differs for some aspects. Concerning pathology, in the old patient fibro-sclerotic and ulcerative aspects predominate and the colic location is more frequent; clinically, in the elderly the occlusive (two out of our four cases) and haemorrhagic complications are seen more than in young-adults; sometimes the symptoms are poor so that a diagnostic delay occurs, with a possible worsening of prognosis. Regarding the treatment of Crohn’s disease it, especially in old patients, must be medical, excluding peculiar situations which need surgical treatment (acute complications, unresponsiveness to drugs). Most frequent operations are segmentary ileal resections and ileocecal resections, as it happened in our experience. Post-operative morbidity and mortality are higher in the elderly, comparing to adult rates, because of more frequent cardiac and respiratory complications, due usually to pre-existing conditions.

CONCLUSIONS: Crohn’s disease affects old patients in 10-15% of cases. In this age-group it is mandatory to suspect the presence of this disease even if the clinical exam is poor, so that specific diagnostic investigations are carried out in order to avoid lost of time, which can be responsible of an unsuccessful treatment. The treatment is essentially medical; surgery, if necessary, must be as most conservative as possible.