Abstract
The charts of 384 patients with Crohn's disease were reviewed to assess the prognostic value of a bowel stenosis documented at the time of initial diagnosis for the occurrence of perforating (abscess, fistula, free perforation) or obstructing complications requiring surgical intervention. Mean follow-up was 5.6 years. At time of diagnosis a bowel stenosis (S) was documented in 143 patients (37.2%). 130 patients underwent surgery, 62 (48%) for obstruction, 18 (14%) for a perforating complication, 12 (9%) for both obstructing and perforating complication and 38 (29%) for intractable disease. The cumulative rates of surgery were calculated using lifetable analysis. The presence of a stenosis at the time of initial diagnosis was a risk factor for the likelihood of surgery overall [65% (S) vs. 40% (no S) after 10 years; P>0.001] and of surgery for obstruction [70% (S) vs. 34% (no S); P>0.001] but did not increase the likelihood of a perforating complication [24% (S) vs. 29% (no S); n.s.]. A perforating complication requiring surgery may therefore not be predicted by the mere diagnosis of a stenosis. Prophylactic surgery of stenotic lesions in patients with Crohn's disease to prevent the development of a perforating complication therefore is not recommended.
Résumé
Les dossiers de 384 malades atteints de maladie de Crohn ont été revus pour évaluer la valeur pronostic d'une sténose intestinale au moment du diagnostic initial pour la survenue d'une complication perforative (abcès, fistule, perforation libre) ou obstructive nécessitant une intervention chirurgicale. Le suivi moyen était de 5,6 ans. Au temps du diagnostic une sténose intestinale (S) était relevée chez 143 patients (37,2%). 130 patients ont subi une chirurgie, 62 (48%) pour obstruction, 18 (14%) pour une complication perforative, 12 (9%) pour une complication à la fois obstructive et perforative et 38 (20%) pour une maladie résistante au traitement. Les taux cumulatifs de chirurgie furent calculés en utilisant une analyse de survie. La présence d'une sténose au moment du diagnostic initial était un facteur de risque avec de probabilité de chirurgie au total de 65% (S) vs. 40% (no S) après 10 ans (P>0.001) et de chirurgie pour obstruction de 70% (S) vs. 34% (no S) (P>0.001) mais n'augmentait pas la probabilité d'une complication perforative (24% S vs. 29% no S; n.s.). Une complication perforative nécessitant la chirurgie peut toutefois ne pas être prévue par le simple diagnostic d'une sténose. La chirurgie prophylactique des lésions sténotiques chez les patients avec une maladie de Crohn pour prévenir le développement d'une complication perforative pour le simple diagnostic de sténose. La chirurgie prophylactique des lésions sténotiques chez les patients avec une maladie de Crohn pour prévenir le developpement d'une complication perforative n'est cependant pas recommandée.
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Makowiec, F., Jehle, E.C., Köveker, G. et al. Intestinal stenosis and perforating complications in Crohn's disease. Int J Colorect Dis 8, 197–200 (1993). https://doi.org/10.1007/BF00290305
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DOI: https://doi.org/10.1007/BF00290305