Abstract: Objective:To explore the surgical treatment and prognosis of incidental Crohn′s disease (CD) during operation.
Methods:The retrospective cohort study was conducted. The clinical data of 81 patients who were originally diagnosed with incidental CD during operation and admitted to the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine between January 2012 to June 2016 were collected. Thirtyone patients underwent surgical treatment after relative examinations according to the clinical manifestation and 50 referrals after the operation underwent relative treatment. Observation indicators included (1) overall surgical situations: surgical indications, surgical procedures and postoperative complications. (2) Subsequent treatment: postoperative medication. (3) Followup: CDrelated reoperation (excluding reoperation due to initial surgeryrelated complication, ostomy reversal and anal fistula operation). Followup using outpatient examination and telephone interview was performed to detect the CDrelated reoperation up to August 2016. SPSS software was used for all statistical analyses. Measurement data with normal distribution were represented as ±s, and measurement data with skewed distribution were described as M (range). Count data were analyzed using the Fisher exact probability. The reoperation curve was drawn by the KaplanMeier method.
Results:(1) Overall surgical situations: ① surgical indications: of 81 patients, 23, 22, 17, 7, 5, 4, 1, 1, and 1 patients had respectively acute appendicitis,gastrointestinal tract obstruction, gastrointestinal perforation, intraabdominal abscess or gastrointestinal hemorrhage, suspected intestinal tumor, intestinal fistula, foreign bodies in intestinal tract and enterovesical fistula. Sixtythree patients underwent emergency operations and 18 underwent selective operations. ② Surgical procedures: single appendectomy, ileocecal resection, segmental resection of colon, segmental resection of small intestine, simple repair of perforation, distal subtotal gastrectomy and foreign bodies removal in intestine tract+repair were performed in 17, 14, 9, 36, 3, 1 and 1 patients, respectively. ③ Postoperative complications: of 81 patients, 15 had postoperative complications in ClavienDindo Grade Ⅱand above, including 12 with intestinal fistula or abdominal abscess and 3 with intestinal obstruction. (2) Subsequent treatment: 66 of 81 patients received postoperative medication for CD (some patients received multiple treatments), including 40 using immunosuppressive agents, 34 using mesalamine, 22 using biologics and 18 using steroids therapy. (3) Followup: all the 81 patients were followed up for 6 months to 23 years, with a median time of 3 years. Twentyfour patients underwent reoperations due to the surgical recurrence during the followup. The 3, 5, 10year reoperation rates were 12.3%, 17.3% and 24.7%, respectively.
Conclusion:Surgeons should enhance the recognition to select the proper surgical treatment for incidental CD during operation and improve the prognosis of patients.