The Fate of the Rectal Segment after Diversion of the Fecal Stream in Crohn??s Disease: Its Implications for Surgical Management

Korelitz, Burton I.; Cheskin, Lawrence J.; Sohn, Norman; Sommers, Sheldon C.

doi:10.1097/00004836-198502000-00005

Cited by 64 publications

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“…According to both the aforementioned arguments and the results of the present paper, limited resection must be considered as the most sensible approach to the surgi cal treatment of Crohn's disease. Despite the fact that no involved resectional margins were reported in cases of colorectal involvement, this study agrees with all authors [3, 6,11,12,14,15,18] that there is a high risk of rectal involvement. Nevertheless, such a protocol may enable patients to live through the early years of their adult life without a stoma, and secondary proctectomy, if neces sary, can always be performed.…”

Section: Discussionsupporting

confidence: 92%

Surgical Management of Crohn’s Disease: How Much to Resect?

et al. 1987

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To determine the optimal length of bowel resection in the treatment of Crohn’s disease, we evaluated the influence of involvement of resection margins on the recurrence rate. This study involves 87 patients who underwent surgery for Crohn’s disease. Among the 91 surgical procedures performed, histology showed involvement of resection margins in 18 cases. Recurrent disease occurred in 33.3% of patients with involved resection margins as opposed to 27.4% of patients with disease-free margins. The difference between these two groups is not significant (χ² = 0.249). As a result of this data and according to other reports, we conclude that limited resection in the surgical treatment of Crohn’s disease is justified.

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Section: Discussionsupporting

confidence: 92%

Surgical Management of Crohn’s Disease: How Much to Resect?

et al. 1987

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“…The appearance of the mucosa in excluded colon segments seen via endoscopy may go from macroscopically normal to different degrees of inflammation with erythema, friability, erosion with spontaneous bleeding, edema or inflammatory polyps 5,7 . In more severe cases, aphthoid 20 . Such characteristics, particularly in patients undergoing intestinal deviation as a result of complications in inflammatory diseases, cause problems in the differential diagnosis between exacerbation crises in preexisting inflammatory diseases and the development of DC, which makes it difficult to indicate whether intestinal transit should be reestablished 6 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation by computerized morphometry of histopathological alterations of the colon wall in segments with and without intestinal transit in rats

et al. 2008

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Purpose:To evaluate histopathological alterations of the colon wall in segments with and without intestinal transit, by computer-assisted imaging, and to correlate these with the length of time diversion. Methods: Thirty male Wistar rats were subjected to intestinal transit diversion by a proximal colostomy and distal mucosa fistula. The animals were divided into three experimental groups according to how long after the initial surgical procedure they were sacrificed: six, twelve and eighteen weeks. Colon segments with and without transit were subjected to histopathological study. The variables colon crypt length, mucosal ulceration, muscle layer thickness of the muscularis mucosa, submucosa and muscularis propria, vascular congestion, number of caliciform cells, inflammatory grade and degree of inflammation, comparing the two colon segments in the different experimental groups were studied. Intestinal crypt length, muscle layer thickness of the mucosa, submucosa and muscularis propria and caliciform cells were measured by computer-assisted imaging method. Mean equality, variance analysis and correlation tests were used in the statistical analysis, and the significance level was set at 5%. Results:Comparison between segments with and without transit showed that the latter presented reduced length of colon crypts and increased muscle layer thickness of the muscularis mucosa, submucosa and muscularis propria. There were greater quantities of ulceration of the mucosal and greater degree of inflammation with increasing time without transit. Mucosal ulceration, submucosal vascular congestion, increased thickness of the submucosal and muscularis propria layers, presence of caliciform cells, inflammatory infiltrate and inflammatory grade correlated significantly with the length of time without transit. Conclusions: Histological alterations occurred in all layers of the colon wall, in the segments without intestinal transit. Ulcerations in the intestinal mucosa, increased number of caliciform cells, greater vascular congestion of the submucosal layer and inflammatory reaction were related to increasing length of time without transit. Key words: Colon. Colitis. Colostomy. Image Processing, Computer-Assisted. Rats. RESUMOObjetivo: Avaliar por método de imagem assistida por computador as alterações histopatológicas da parede cólica em segmentos providos e desprovidos de trânsito intestinal e relacioná-las ao tempo de exclusão. Métodos: Trinta ratos Wistar machos foram submetidos à derivação do trânsito no cólon esquerdo por meio de colostomia proximal e fístula mucosa distal. Os animais foram divididos em três grupos experimentais segundo o sacrifício ter sido realizado seis, doze e dezoito semanas após o procedimento cirúrgico inicial. Segmentos dos cólons providos e desprovidos de trânsito foram submetidos a estudo histopatológico. Foram analisadas as variáveis: comprimento das criptas cólicas, ulceração na mucosa, espessura das camadas muscular da mucosa, submucosa e muscular própria, congestão vascular, número...

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“…As seen via endoscopy, excluded segments of colon mucosa may vary in appearance from macroscopically normal to differing degrees of inflammation, with erythema, friability, erosion with spontaneous bleeding, edema or inflammatory polyps 2 . In more severe cases, aphthoid ulcers that are practically indistinguishable from those found in cases of UC are formed 3 . These characteristics, especially in patients undergoing intestinal deviation because of complications from UC, make it problematic to determine the differential diagnosis between exacerbation crises of the preexisting disease and the development of DC.…”

Section: Introductionmentioning

confidence: 97%

Tissue quantification of neutral and acid mucins in the mucosa of the colon with and without fecal stream in rats

et al. 2009

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Purpose:To quantify the intensity of the expression of neutral and acids mucins in mucosa of the colon with and without fecal stream and to correlate this with the duration of fecal transit diversion. Methods: Thirty male Wistar rats were subjected to fecal transit deviation in the left colon by a proximal colostomy and a distal mucous fistula. The animals were divided into three experimental groups, according to whether sacrificing would be performed six, 12 or 18 weeks after surgery. The expression of neutral and acid mucins was evaluated using the histochemical techniques of Periodic Acid Schiff and Alcian Blue, respectively. The tissue mucins expression was quantified by computer-assisted image analysis software (NIS-Elements) in the segments with and without fecal stream. Student's paired t test was used to compare the quantities of mucins in colon with or without fecal stream and variance between the experimental groups by ANOVA and Newman-Keuls post-test, establishing level of signification of 5% (p<0.05). Results: There were significant decreased quantities of acid and neutral mucins in the colon without transit, compared with the colon with fecal stream, independent of the duration of exclusion. There was increased expression of neutral mucins in the colon with fecal stream after 12 and 18 weeks of exclusion. There was no increase in the expression of acid mucins in the colon with transit as the duration of fecal transit exclusion progressed. There was increased production of acid mucins in the animals submitted to diversion of the fecal stream for 18 weeks, compared with those subjected to diversion for 6 and 12 weeks. In the colon without fecal stream, there was increased expression of neutral mucins after 12 and 18 weeks of exclusion. Conclusions: Deviation of the fecal stream decreased the expression of acid and neutral mucins in the segments without fecal transit, compared with segments with transit. Regardless of the reduced expression of acid and neutral mucins in the segments without fecal stream, their tissue expression increased with increasing duration of intestinal deviation. Key words: Colitis. Colostomy. Mucins. Sialomucins. Image Processing, Computer-Assisted. RESUMOObjetivo: Quantificar a intensidade de expressão de mucinas neutras e ácidas na mucosa cólica provida e desprovida de trânsito intestinal relacionando-a ao tempo de exclusão fecal. Métodos: Trinta ratos Wistar machos foram submetidos à derivação do trânsito no cólon esquerdo por colostomia proximal e fístula mucosa distal. Os animais foram divididos em três grupos experimentais segundo o sacrifício ter sido realizado seis, 12 e 18 semanas após a cirurgia. A avaliação da expressão de mucinas neutras e ácidas na mucosa cólica foi realizada com as técnicas histoquímicas do Periódico Ácido de Schiff e Azul de Alcian, respectivamente. A quantificação da expressão tecidual das mucinas foi com auxílio de programa de análise de imagem assistida por computador (NIS-Elements) nos segmentos providos e desprovidos de trânsito fec...

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The Fate of the Rectal Segment after Diversion of the Fecal Stream in Crohn??s Disease: Its Implications for Surgical Management

Cited by 64 publications

References 0 publications

Surgical Management of Crohn’s Disease: How Much to Resect?

Surgical Management of Crohn’s Disease: How Much to Resect?

Evaluation by computerized morphometry of histopathological alterations of the colon wall in segments with and without intestinal transit in rats

Tissue quantification of neutral and acid mucins in the mucosa of the colon with and without fecal stream in rats

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