Original article
Intestinal perforation in Crohn's disease: Factors predictive of surgical resectionPerforation intestinale au cours de la maladie de Crohn: facteurs prédictifs de chirurgie

https://doi.org/10.1016/S0399-8320(05)82174-8Get rights and content

Summary

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.

Résumé

La maladie de Crohn perforée est classiquement traitée chirurgicalement mais l’apparition de nouveaux traitements médicaux remet en cause cette attitude.

Objectifs

Evaluer dans la maladie de Crohn les facteurs prédictifs de chirurgie pour perforation intestinale et définir les malades pouvant bénéficier d’un traitement non chirurgical.

Malades et méthodes

Cent soixante-deux malades consécutifs atteints de maladie de Crohn (69 hommes, 93 femmes, âge moyen 39 ans) ayant développé une perforation intestinale (fistule, abcès, plastron ou pseudo-tumeur inflammatoire) entre 1995 et 2003 ont été étudiés rétrospectivement.

Résultats

Cent cinquante et un malades (93 %) ont été opérés, 70 de façon programmée et 81 pour échec du traitement médical (probabilités cumulées à 2 ans de chirurgie quelle qu’elle soit 0,89 ± 0,03, de chirurgie non programmée 0,72 ± 0,05). Les facteurs prédictifs de chirurgie non programmée étaient l’hyperplaquettose (HRA 3,15; IC 95 % 2,21-4,50) et l’absence de fistule (HRA 3,14; IC 95 % 2,48-3,99). Le taux de complications et de stomies et la longueur d’exérèse du tube digestif n’étaient pas significativement différents que la chirurgie ait été programmée ou non.

Conclusion

Environ un quart des malades non opérés d’emblée pour perforation intestinale sur maladie de Crohn, surtout ceux porteurs de fistule, pourraient bénéficier d’un traitement non chirurgical.

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