Document Detail


Positive histological inflammatory margins are associated with increased risk for intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn's disease.
MedLine Citation:
PMID:  23044672     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Rates of postoperative complications are particularly high among patients with Crohn's disease.
OBJECTIVE: The aim of this study was to assess whether positive inflammatory histological margins, among other factors, pose a risk for intra-abdominal septic complications in patients with Crohn's disease undergoing ileocolic resection.
DESIGN: A retrospective study of patient records, during 2000-2010, was conducted.
SETTINGS: This investigation was performed at a single medical center.
PATIENTS: Included were 166 individuals with Crohn's disease (85 males, mean age 35.6).
INTERVENTION: Ileocolic resection with primary anastomosis was performed.
MAIN OUTCOME MEASURE: The primary outcomes measured were postoperative intra-abdominal septic complications.
RESULTS: Twenty-five patients (15%) developed intra-abdominal septic complications, including anastomotic leak, intra-abdominal abscesses and collections, and enterocutaneous fistulas. There were no postoperative deaths. Univariate analysis revealed that a long course of disease before surgery, an emergency surgery, steroid treatment of more than 3 months before surgery, additional sigmoidectomy, and positive surgical margins detected on histopathological examination were associated with intra-abdominal septic complications. In a multivariate analysis, only disease duration longer than 10 years (OR 4.575 (CI 1.592-13.142), p = 0.005), additional sigmoidectomy (OR 5.768 (CI 1.088-30.568), p = 0.04), and positive histological resection margins (OR 2.996 (CI 1.085-8.277), p = 0.03) were found to be independent risk factors.
LIMITATIONS: This study was limited by the incomplete data regarding preoperative albumin levels.
CONCLUSIONS: Positive histological margins, disease duration of more than 10 years, and added sigmoidectomy are independent risk factors that are associated with postoperative intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn's disease. These risk factors should be considered when the need for a diverting stoma is questionable. A frozen section of the margins may assist in the decision as to a temporary ileostomy construction.
Authors:
Omri Shental; Hagit Tulchinsky; Ron Greenberg; Joseph M Klausner; Shmuel Avital
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-09     Completed Date:  2012-12-21     Revised Date:  2013-04-17    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1125-30     Citation Subset:  IM    
Affiliation:
Department of Surgery, Tel-Aviv Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Abscess / etiology
Adult
Anastomosis, Surgical / adverse effects
Anastomotic Leak / etiology
Colectomy / adverse effects
Colon / surgery*
Colon, Sigmoid / surgery
Confidence Intervals
Crohn Disease / pathology*,  surgery*
Cutaneous Fistula / etiology*
Female
Humans
Ileum / surgery*
Inflammation / complications,  pathology
Intestinal Fistula / etiology*
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Retrospective Studies
Risk Factors
Time Factors
Young Adult
Comments/Corrections
Comment In:
Dis Colon Rectum. 2013 Apr;56(4):e50   [PMID:  23478622 ]
Dis Colon Rectum. 2013 Apr;56(4):e50   [PMID:  23478623 ]

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