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Surgery and diagnostic imaging in abdominal Crohn’s disease

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Abstract

Surgery is well-established option for the treatment of Crohn’s disease that is refractory to medical therapy and for complications of the disease, including strictures, fistulas, abscesses, bleeding that cannot be controlled endoscopically, and neoplastic degeneration. For a condition like Crohn’s disease, where medical management is the rule, other indications for surgery are considered controversial, because the therapeutic effects of surgery are limited to the resolution of complications and the rate of recurrence is high, especially at sites of the surgical anastomosis. In the authors’ opinion, however, surgery should not be considered a last-resort treatment: in a variety of situations, it should be regarded as an appropriate solution for managing this disease. Based on a review of the literature and their own experience, the authors examine some of the possibilities for surgical interventions in Crohn’s disease and the roles played in these cases by diagnostic imaging modalities.

Riassunto

La chirurgia è un’opzione terapeutica consolidata per il trattamento della malattia di Crohn refrattaria alla terapia medica e per le complicanze legate a tale patologia quali stenosi, fistole, ascessi, sanguinamento non trattabile endoscopicamente, oltre che per i casi di degenerazione neoplastica. Per condizioni come la malattia di Crohn nelle quali il trattamento medico ha un ruolo primario, altre indicazioni per la chirurgia sono controverse, poiché i suoi effetti terapeutici sono limitati alla risoluzione delle complicanze, e la frequenza di recidive è alta, soprattutto a livello dell’anastomosi. Secondo l’opinione degli autori, tuttavia, la chirurgia non deve essere considerata come ultima opzione di trattamento: in diverse situazioni dovrebbe essere ritenuta come una soluzione adeguata nel trattamento multidisciplinare della patologia. Basandosi sulla revisione della letteratura corrente e sulla propria esperienza, gli autori hanno esaminato alcune possibilità di intervento chirurgico nella malattia di Crohn ed il ruolo che svolgono in queste condizioni le tecniche di imaging.

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Conflict of interest

Fiorenzo Botti, Flavio Caprioli, Diego Pettinari, Alberto Carrara, Andrea Magarotto, Ettore Contessini Avesani declare that they have no conflict of interest.

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  1. Unità Operativa di Chirurgia Generale e d’Urgenza, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy

    Fiorenzo Botti, Diego Pettinari, Alberto Carrara & Ettore Contessini Avesani

  2. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy

    Fiorenzo Botti, Flavio Caprioli, Alberto Carrara & Ettore Contessini Avesani

  3. Unità Operativa di Gastroenterologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy

    Flavio Caprioli

  4. Scuola di Specializzazione in Gastroenterologia ed Endoscopia Digestiva, Università degli Studi di Milano, Milan, Italy

    Andrea Magarotto

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  1. Fiorenzo Botti
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Correspondence to Fiorenzo Botti.

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Botti, F., Caprioli, F., Pettinari, D. et al. Surgery and diagnostic imaging in abdominal Crohn’s disease. J Ultrasound 18, 3–17 (2015). https://doi.org/10.1007/s40477-013-0037-6

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