Early operation (open or laparoscopic) does not carry a higher risk of mortality and morbidity compared to delayed operation and should be the preferred surgical approach for patients with acute lithiasic cholecystitis.

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Severe gastrointestinal hemorrhage is an uncommon complication of Crohn's disease. Most bleeding episodes originate from colonic ulcers or ulcerated areas. The management of severe gastrointestinal bleeding in Crohn's disease is a therapeutic challenge. Several approaches including surgical resection, specific medical therapy of Crohn's disease, endoscopic treatment, or angiographic intervention have been attempted, but recurrence of bleeding is high. Monoclonal anti TNFalpha antibodies (infliximab) can induce relatively rapid mucosal healing. We report two cases of severe recurrent Crohn's disease presenting with massive lower gastrointestinal bleeding in which infliximab induced rapid mucosal healing and prevented recurrent bleeding.

Aim: To perform a meta‐analysis to assess the effectiveness and safety of oral budesonide for inducing remission in active Crohn’s disease and for preventing relapse in Crohn’s disease with medically‐ or surgically‐induced remission. Methods: All randomized, double‐blind controlled trials involving oral budesonide therapy in Crohn’s disease were retrieved from a Medline search, reviews articles or their bibliographies. Of 83 articles retrieved, 12 met the inclusion criteria. Data extraction was performed by three independent observers and scoring disagreements were resolved by consensus. Results: Six trials tested budesonide in active disease and six in quiescent disease. Budesonide was less effective than conventional corticosteroids for inducing remission of active Crohn’s disease (pooled rate difference, RD –8.5%; 95% CI: –16.4 to –0.7%; P=0.02), but corticosteroid‐related adverse events were reduced (RD –22.4%; 95% CI: –32 to –12.8%; P < 0.001). In quiescent Crohn’s disease, budesonide was as effective as placebo for preventing relapse in medically induced remission (RD –0.8%; 95% CI: –9.9 to 8.3%; P=0.42) and endoscopic recurrence in surgically induced remission (RD –3.5%; 95% CI: –16.9 to 9.8%; P=0.30). In the long term treatment, budesonide had an occurrence rate of corticosteroid‐related adverse effects similar to placebo (RD 5.3%; 95% CI: –3.9 to 14.5%; P=0.30). Conclusions: Budesonide is significantly less effective than conventional corticosteroids for inducing remission in active Crohn’s disease, but the risk of corticosteroid‐related adverse effects is significantly reduced. Budesonide is not effective in preventing relapse of Crohn’s disease after medically‐ or surgically‐induced remission.

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