Inflammatory Bowel Diseases: the Surgical Perspective

Abstract

Inflammatory bowel diseases (IBD), namely Crohn's disease and ulcerative colitis, are relatively rare diseases in our country, known as a low prevalence geographic region. IBD are a multidisciplinary problem, that implies gastroenterologists, as well as surgeons. Surgical management in inflammatory bowel disease is often impaired by a high complication rate and a signifi cant recurrence rate, specifi c mostly for Crohn's disease. Indications for surgery include failure of medical therapy (including delayed puberty for young patients and drug intolerance), toxic megacolon, bowel perforation, obstruction, enteric fi stula and abdominal or perianal abscess. Advances in medical treatment options for IBD are continuously accumulating. However, a large number of patients still require surgical procedures during lifetime. RezumatBolile inflamatorii intestinale, cuprinzând boala Crohn și colita ulcerativă, sunt boli relativ rare în ţara noastră, cunoscută ca o regiune geografi că cu prevalenţă scăzută. Bolile inflamatorii intestinale reprezintă o problemă multidisciplinară, care implică atât gastroenterologi, cât și chirurgi. Abordarea chirurgicală în bolile inflamatorii intestinale este adesea afectată de o rată ridicată a complicaţiilor și de o rată semnifi cativă de recurenţă, specifi că mai ales pentru boala Crohn. Indicaţiile intervenţiilor chirurgicale includ eșecul terapiei medicamentoase (inclusiv pubertatea întârziată pentru pacienţii tineri și intoleranţa la medicamente), megacolonul toxic, perforaţiile intestinale, ocluzia, fi stula enterică și abcesul abdominal sau perianal. Opţiunile de tratament medicamentos în bolile inflamatorii intestinale se perfecţionează continuu. Cu toate acestea, un număr mare de pacienţi încă necesită proceduri chirurgicale de-a lungul vieţii. Cuvinte cheie: boli inflamatorii intestinale, boala Crohn, colita ulcerativă, chirurgie. REVIEW

Small bowel adenocarcinoma arising in longstanding fibrostenotic Crohn’s disease

“…IBDs are lifelong conditions with an individual pattern of flares and remission periods and with permanent potential of complications. Although both ulcerative colitis (UC) and CD (CD) share an immune mediated chronic inflammation, the propensity for malignant transformation and perforations differ considerably (6). UC is not a transmural disease; hence it does not produce strictures or perforations, but it does cause bowel cancer in 20% percent of the patients after 30 years of active disease.…”

“…In addition to the presence of tumor proliferation, the remaining intestinal wall showed histopathological changes suggestive of active CD: deep erosions of the intestinal mucosa, villoglandular destruction, extensive foci of pseudo pyloric metaplasia, areas of fibrosis, sarcoid-like granulomas located deep in the intestinal wall and even in the vicinity of tumor contingent, marked interstitial edema of the lamina propria and marked basal plasmacytosis (figs. 6,7,8). Twenty-five locoregional lymph nodes were identified and evaluated (hematoxylin eosin staining), of which 9 shows tumor invasion (pN1)-lymph node metastasis with cells in the "signet cells" (fig.…”