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Preoperative cross-sectional imaging findings in patients with surgically complex ileocolic Crohn’s disease

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Abstract

Purpose

The aim of this study was to evaluate the diagnostic performance of preoperative cross-sectional imaging findings using the SAR-AGA definitions in Crohn’s disease (CD) patients who underwent ileocolic resection (ICR) with and without surgically complex ileocolic CD (CIC-CD).

Methods

69 CD patients [38 men; mean (± SD) age: 40.6 (16.2) years] who underwent ICR were retrospectively classified by surgical complexity by a colorectal surgeon using operative findings. CIC-CD was defined as ileal CD, not confined to the distal ileum. Two radiologists retrospectively evaluated the preoperative imaging for the presence and type of penetrating disease, stricture, or probable stricture using the SAR-AGA consensus definitions. The diagnostic performance of preoperative imaging findings was compared for patients with and without CIC-CD. Estimated blood loss (EBL), operative time (OT), conversion to open surgery, diversion, and length of hospital stay (LOS) were compared.

Results

60.9% had CIC-CD and 79.7% underwent primary ICR. Penetrating disease was more common in patients with than without CIC-CD (76.2% vs. 40.7%, p = 0.0048) and similar among primary versus redo ICR (p = 0.12). Patients with CIC-CD had more complex fistulas (59.5% vs. 11.1%; p < 0.0001) and fewer simple fistulas (2.4% vs. 18.5%; p = 0.03) than those without. Mesenteric findings (abscess, inflammatory mass) were more frequent in patients with (35.7%) than without (0%) (p = 0.0002) CIC-CD. Stricture and probable stricture were similar (p = 0.59). CIC-CD patients had greater EBL (178 cc vs. 57 cc, p = 0.006), conversion rates (30% vs. 0%, p = 0.0026), and diversion (80% vs. 52%, p = 0.04).

Conclusion

Complex fistula, mesenteric abscess, or inflammatory mass defined by the SAR-AGA guidelines suggests CIC-CD. ICR for CIC-CD had greater EBL, conversion to open surgery, and diversion.

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Authors and Affiliations

  1. NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA

    Bari Dane, Luke Ginocchio & Chenchan Huang

  2. NYU Langone Health Department of Surgery, 550 1st Avenue, New York, NY, 10016, USA

    Feza H. Remzi, Michael Grieco, Arman Erkan, Eren Esen & Volkan Dogru

Authors
  1. Bari Dane
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  2. Feza H. Remzi
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  3. Michael Grieco
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  4. Luke Ginocchio
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  5. Arman Erkan
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  6. Eren Esen
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  7. Volkan Dogru
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  8. Chenchan Huang
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Corresponding author

Correspondence to Bari Dane.

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Conflict of interest

The authors declare that they have no conflict of interest.

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This study was institutional review board approved and Health Insurance Portability and Accountability Act compliant.

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Dane, B., Remzi, F.H., Grieco, M. et al. Preoperative cross-sectional imaging findings in patients with surgically complex ileocolic Crohn’s disease. Abdom Radiol 48, 486–493 (2023). https://doi.org/10.1007/s00261-022-03716-w

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  • DOI: https://doi.org/10.1007/s00261-022-03716-w

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