Management of inflammatory bowel diseases in urgent and emergency scenario

Gomes, Carlos Augusto; Podda, Mauro; Veiga, Sabrina Carpanez; Cabral, Tayenne do Vale; Lima, Luiza Verardo; Miron, L; Oliveira, Vanessa de; Aranha, Gabriel Lunardi

doi:10.1016/j.jcol.2019.10.012

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Most emergencies related to inflammatory bowel disease should be treated non-operatively first, emphasising the patient's hemodynamic status. In some cases of life-threatening complications, urgent surgical treatment is mandatory [29]. Medical treatment should be offered as the first line for acute bowel obstruction due to digestive stenosis or inflammation [30].…”

Section: Studymentioning

confidence: 99%

Immediate Results of Small Bowel Crohn’s Disease Surgery

Anou¹,

Bendib²,

Smail³

2023

African Journal of Biology and Medical Research

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Introduction: Despite the progress made in the medical management of Crohn's disease (CD), a vast number of patients are operated on at least once in their lifetime. Although this is a mild disease that occurs mainly in young patients with little comorbidity, CD surgery is accompanied by significant postoperative morbidity (PO). This study aims to analyse the PO complications of the small intestine's CD and look for the risk factors for its occurrence. Patients and methods: this is a single-centre prospective study that collected 83 files of patients operated on for CD of the small intestine for 28 months (May 2017 - September 2019). All patients had histologic confirmation of CD. Isolated anoperineal and colorectal forms were excluded from this work. PO morbidity is defined by all complications occurring during the first 30 days of PO. A statistical analysis of PO morbidity was performed as a function of 12 parameters: age; sex; comorbidity; history of abdominal surgery; history of surgery for CD; haemoglobin level (Hb <or> at 10 mg/dl); albumin level (<or> at 34g / l); BMI (<or> at 19); ASA score; mode of surgery (cold vs emergency); intra-abdominal abscess; operative procedure (resection-anastomosis vs resection-stoma). Statistical analysis was performed first univariate and then multivariate (SPSS 16 software). Results: These were 56 women and 27 men, with a sex ratio of 2. The mean age of the patients was 35 years (13-65). The overall PO morbidity rate was 26%; this morbidity was surgical in 86%, septic in 89.5% and intra-abdominal septic in 50% of cases. Complications were major (CMPO) in 39.5% of cases. The mode of emergency surgery was an independent risk factor for the occurrence of complications (p = 0.005). Conclusion: Small intestine CD surgery is associated with very high PO morbidity. The mode of emergency surgery is an independent risk factor for the onset of PO complications. Patients who require surgery should be operated on as elective or scheduled surgery. The indications for emergency surgery for CD are sporadic.

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Section: Studymentioning

confidence: 99%

Immediate Results of Small Bowel Crohn’s Disease Surgery

Anou¹,

Bendib²,

Smail³

2023

African Journal of Biology and Medical Research

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“…Determinados factores explicarían estos resultados, desde el uso preoperatorio de corticoides sistémicos hasta acudir a la emergencia hospitalaria cuando ya existen signos de peritonitis o toxicidad sistémica (45,46) . Respecto a la terapia postoperatoria, los anti-TNFs asociados a azatriopina se usaron en más de la mitad de pacientes con EC (58%), en relación a lo recomendado por consensos internacionales, donde su uso ha demostrado menor recurrencia de la enfermedad a largo plazo (13,47) . Por otro lado, en el grupo de CU, los pacientes recibieron terapia de mantenimiento con 5-ASA y biológicos, ambos asociados a azatioprina.…”

Section: Tipo De Cirugía Ec (N=17) Cu (N=5)unclassified

“…Todas las cirugías realizadas fueron de tipo convencional, sin embargo, recomendaciones actuales prefieren la cirugía laparoscópica por ofrecer una menor estancia hospitalaria y menor morbilidad postoperatoria, excepto en casos complejos o de emergencia (13,47) . De la misma manera, se debe mencionar que en las cirugías de emergencia participan un equipo de cirujanos especialistas en aparato digestivo principalmente, a diferencia de las cirugías electivas en donde intervienen cirujanos colorrectales; al respecto, Biondo et al, refiere que la especialización en cirugía colorrectal tiene una influencia significativa sobre la morbilidad y mortalidad de las cirugías colorrectales de emergencia (48) , lo que contribuiría en mejores resultados para estos pacientes.…”

Section: Tipo De Cirugía Ec (N=17) Cu (N=5)unclassified

Manejo médico quirúrgico de la enfermedad inflamatoria intestinal moderada-severa

Méndez

Pérez

Marcacuzco

et al. 2021

Rev Gastroenterol Peru

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El tratamiento de la enfermedad inflamatoria intestinal (EII) es principalmente médico, sin embargo, más del 70% de pacientes con enfermedad de Crohn (EC) y 25% con colitis ulcerativa (CU) requerirán cirugía. Objetivos: Evaluar el manejo médico- quirúrgico y evolución en pacientes con EII moderada-severa. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo de enero del 2011 a diciembre del 2019 en el Servicio de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, Lima-Perú. Resultados: Se incluyó 22 pacientes con EII, 17 con EC y 5 con CU. El 59% fueron masculinos. Se realizó cirugía de emergencia en el 35,2% y el 60% de los pacientes con EC y CU respectivamente. La estenosis y el megacolon tóxico fueron las indicaciones más frecuentes. Según el tipo de cirugía, la hemicolectomía (41%) y la resección intestinal (41%) fueron las más frecuentemente realizadas en EC, mientras que, en CU fue la colectomía total (60%). Dentro de las complicaciones postquirúrgicas, las dehiscencias/fistulas y colecciones intraabdominales fueron las más frecuentemente reportadas en EC; mientras que, en CU fue la infección del sitio operatorio e íleo adinámico. Luego de cirugía, los biológicos y los 5-ASA asociados a inmunomodulador fueron el tratamiento más utilizados en EC y CU respectivamente. La mortalidad fue del 17,6% en EC y 60% en CU. Conclusiones: El tratamiento quirúrgico es una op la EII moderada-severa. La cirugía de emergencia en EII continúa presentando una alta morbimortalidad.

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“…Literature suggests that childhood-onset disease may have a more severe course, with a 30-40% colectomy rate at the age of ten, as compared with 20% in adults [5]. Surgery is performed in cases of acute severe or fulminant colitis, massive colorectal hemorrhage, bowel obstruction, toxic megacolon, and perforation [2,4,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Quality of life after Colectomy and Ileo-Jpouch-anal anastomosis in paediatric patients with Ulcerative Colitis

Wong,

Rotondi,

Roso

et al. 2024

Preprint

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INTRODUCTION Ulcerative Colitis (UC) is an Inflammatory Bowel Disease (IBD). Surgery is required in cases of severe acute colitis, massive hemorrhage, toxic megacolon, and perforation; in such cases colectomy and JpouchIleoanal anastomosis (IPAA) are performed. The aim of this study was to evaluate functional outcome, and patient satisfaction and Quality of Life (QoL) after surgery. MATERIAL AND METHODS Questionnaires were administered to 24 patients with UC undergoing surgery from 2011 to 2022. RESULTS Mean age at IPAA was 10.8 years. Twenty patients underwent IPAA in 3 operations, 4 patients in 2. All patients underwent laparoscopic surgery. Six months after surgery mean level of satisfaction was 8.7/10, perception of health status was 7.4. Twenty-three patients (95.8%) recommended IPAA. For 20 patients (83.3%) surgery did not cause delay in education, while 14 patients (58.3%) played sport. The lowest number of evacuations was 9.2 per day, the highest 13.3. Seventeen patients (70.8%) had no incontinence and 15 patients (62.5%) were not affected by pouchitis. After 12 months mean satisfaction level raised up to 9.2/10, perception of health status to 8.5. School absences decreased and no other patients showed any delay in education. Seventeen (70.8%) patients played sports. The number of evacuations decreased: the lowest number was 5.1 per day, the highest 7.5. Twenty patients (83.3%) were continent and 12 (50%) did not use antibiotics. CONCLUSION Most patients show a good functional outcome in defecation frequency and continence, which has improved through time, number of pouchitis episodes has increased. Patients appear satisfied after surgery. Level of Evidence: III

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Management of inflammatory bowel diseases in urgent and emergency scenario

Cited by 6 publications

References 17 publications

Immediate Results of Small Bowel Crohn’s Disease Surgery

Immediate Results of Small Bowel Crohn’s Disease Surgery

Manejo médico quirúrgico de la enfermedad inflamatoria intestinal moderada-severa

Quality of life after Colectomy and Ileo-Jpouch-anal anastomosis in paediatric patients with Ulcerative Colitis

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