New medical therapeutic options challenge the usual surgical management of Crohn’ s disease patients with intestinal perforation. Objectives-To determine factors predictive of surgery for perforation in Crohn’ s dis...New medical therapeutic options challenge the usual surgical management of Crohn’ s disease patients with intestinal perforation. Objectives-To determine factors predictive of surgery for perforation in Crohn’ s disease and define a group of patients that may benefit from non-surgical treatment. Methods-One hundred and sixty-two patients (69 males, 93 females, mean age 39) with perforated Crohn’ s disease (fistula, abscess, inflammatory mass) between January 1995 and September 2003 were studied retrospectively. Results-One hundred and fifty-one patients (93% ) underwent surgery: 70 had planned surgery and 81 had surgery for symptomatic deterioration. At two years, the cumulative probability of intestinal resection was 0.89 ≥ 0.03, and the cumulative probability of unplanned intestinal resection was 0.72 ≥ 0.05. Predictive factors of unplanned surgery were elevated platelet count (adjusted hazard ratio 3.15; 95% CI 2.21-4.50) and absence of fistula (adjusted hazard ratio 3.14; 95% CI 2.48-3.99). The rate of postoperative complications, the need for a stoma, and the length of bowel resection were not significantly different whether the surgery was planned or not. Conclusion-A significant proportion of patients with intestinal perforation complicating Crohn’ s disease, particularly those with a fistula, might benefit from non-surgical treatment.展开更多
文摘New medical therapeutic options challenge the usual surgical management of Crohn’ s disease patients with intestinal perforation. Objectives-To determine factors predictive of surgery for perforation in Crohn’ s disease and define a group of patients that may benefit from non-surgical treatment. Methods-One hundred and sixty-two patients (69 males, 93 females, mean age 39) with perforated Crohn’ s disease (fistula, abscess, inflammatory mass) between January 1995 and September 2003 were studied retrospectively. Results-One hundred and fifty-one patients (93% ) underwent surgery: 70 had planned surgery and 81 had surgery for symptomatic deterioration. At two years, the cumulative probability of intestinal resection was 0.89 ≥ 0.03, and the cumulative probability of unplanned intestinal resection was 0.72 ≥ 0.05. Predictive factors of unplanned surgery were elevated platelet count (adjusted hazard ratio 3.15; 95% CI 2.21-4.50) and absence of fistula (adjusted hazard ratio 3.14; 95% CI 2.48-3.99). The rate of postoperative complications, the need for a stoma, and the length of bowel resection were not significantly different whether the surgery was planned or not. Conclusion-A significant proportion of patients with intestinal perforation complicating Crohn’ s disease, particularly those with a fistula, might benefit from non-surgical treatment.
