gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2017-27-3-93-100gastro-j-162Research ArticleНОВОСТИ КОЛОПРОКТОЛОГИИNEWS OF COLOPROCTOLOGYХирургическое лечение свищевой формы болезни Крона с пластикой передней брюшной стенки(Клиническое наблюдение)Surgical treatment of the fistulizing Crohn's disease with anterior abdominal wall reconstruction (Clinical case)КиценкоЮ. Е.KitsenkoYu. Ye.yury@kitsenko.ruШифринО. С.ShifrinO. S.noemail@neicon.ruЦарьковП. В.TsarkovP. V.noemail@neicon.ruФГБОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова»РоссияThe State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical UniversityRussian Federation20171208201827393100Copyright © Киценко Ю.Е., Шифрин О.С., Царьков П.В., 20182018Киценко Ю.Е., Шифрин О.С., Царьков П.В.Kitsenko Y.Y., Shifrin O.S., Tsarkov P.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/162

Цель представленного клинического наблюдения. Рассмотреть последствия неверно избранной тактики при подозрении на аппендикулярный инфильтрат, а также возможности и трудности лечения осложненной формы болезни Крона. Основные положения. Описано хирургическое лечение свищевой формы болезни Крона с межорганными и наружными свищами с формированием патологической полости, открывающейся на переднюю брюшную стенку. Длительность заболевания 5 лет. Пациент перенес аппендэктомию при наличии инфильтрата с последующим формированием наружного кишечного свища. Повторная операция по ликвидации свища успеха не имела, однако позволила диагностировать болезнь Крона. Несмотря на отсутствие стойкой ремиссии на фоне терапии инфликсимабом лечение в связи с отказом от операции продолжалось до появления анафилактической реакции на биологический агент. В итоге были выполнены резекция илеоцекального изгиба с фрагментом подвздошной кишки, резекция участка дистальной трети сигмовидной ободочной кишки, восстановление непрерывности кишечника, а также иссечение передней брюшной стенки с системой свищевых ходов и последующей пластикой. Для коррекции дефекта передней брюшной стенки применен коллагеновый аллотрансплантат. При продолжении проведения биологической терапии адалимумабом данных за рецидив заболевания не получено. Заключение. Наличие инфильтрата в правой подвздошной области требует исключения диагноза болезни Крона. При свищевой форме последней лечение следует проводить в условиях специализированных учреждений. Важно отметить, что эффективность лечения при исключительно консервативном ведении, включая биологическую терапию, невысока. Биологическая терапия позволяет уменьшить проявления заболевания и облегчить условия для проведения последующего хирургического вмешательства.

Aim of clinical case presentation. To discuss the consequences of erroneous management approach at suspicion for appendicular infiltrate, as well as options and difficulties of complicated Crohn’s disease treatment. Summary. Surgical treatment of fistulizing Crohn's disease with interorgan and external fistulas with development of pathological cavity having anterior abdominal wall opening is described. Past history of disease was five years. The patient underwent appendectomy in the presence of infiltrate with subsequent development of external intestinal fistula. Repeated surgery for fistula elimination was unsuccessful, however allowed to establish Crohn's disease diagnosis. Patient refused from surgical treatment, therefore despite the lack of permanent remission at infliximab treatment, therapy was maintained until patient developed anaphylactic reaction. As a result, ileocecal resection along with resection of ileum fragment and distal third of sigmoid colon, restoration of intestinal continuity, and resection of anterior abdominal wall with fistulous tract block and subsequent reconstruction were executed. The collagen allo-graft is applied to restore anterior abdominal wall defect. At continuation of biological therapy by adalimumab no data on disease relapse were received. Conclusion. The presence of infiltration in the right iliac area requires ruling out of the Crohn's disease diagnosis. At fistulizing form treatment should be provided at the specialized institutions. It is important to note that treatment efficacy at exclusively conservative management, including biological therapy is quite low. Biological therapy allows to suppress disease manifestations and facilitate conditions for subsequent surgical intervention.

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The authors declare that there are no conflicts of interest present.