Introduction Three out of four Crohn’s patients will undergo intestinal resection.1There are identified risks for post operative complications before their procedure such as malnutrition, abscess, obstruction, and pre operative therapies such as steroids and immunomodulators.2
The Montreal system3of classification attempts to assess disease severity and guide treatment. It divides Crohn’s into pathological subtypes of non penetrating/non stricturing, stricturing and penetrating.
Evidence is limited as to the influence of Crohn’s subtype on anastomotic leak rate following bowel resection; however, it is felt penetrating Crohn’s may have higher risk of anastomotic leak. Our aim was to determine if this is the case.
Method We collected retrospective data on all Crohn’s patients undergoing elective and emergency intestinal resection and anastamosis from March 2008–2014. 64 patients were identified and clinical records analysed for pathological subtype, operation/resection performed with a primary outcome of anastomotic leak. For tests of independence in discrete data fisher’s exact test was used. A p value of <0.05 was deemed statistically significant.
Results We identified 33 males and 31 females with an age range of 15–86 years (mean 45 years). 27 (42%) were emergency procedures ad 37(58%) were elective. The most common procedure was right hemicolectomy (59%) followed by small bowel resection (25%).
Pathology demonstrated 19 cases (30%) of penetrating and 15(23%) cases of stricturing disease. The remaining 30(47%) were non stricturing/non penetrating.
There were 4 post operative anastomotic leaks, all within the penetrating disease group. This was statistically significant when compared to the stricturing and non stricturing/non penetrating groups (p = 0.006).
Conclusion Our small study adds evidence to the suggestion that penetrating Crohn’s subtype is associated with anastomotic leak after intestinal resection. Surgeons operating on Crohn’s patients should be aware of this association and have a high index of suspicion for anastomotic complication in this group. Further study with larger numbers should be performed.
Disclosure of interest None Declared.
Gardiner et al. Operative management of small bowel Crohn’s disease. Surg Clin N Am 2007;87:587–610
Samimi et al. Outcome of medical treatment of stricturing and penetrating Crohn’s disease: a retrospective study. Inflamm Bowel Dis 2010;16:1187–1194
Silverberg et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19(Suppl A):5A–36A