Efficacy of ileostomy in Crohn's disease of the large intestine with perianal involvement
Abstract
Aim of investigation. To estimate efficacy of ileostomy in patients with Crohn's disease of the large intestine with perianal involvement.
Material and methods. Overall 43 patients with Crohn's disease of the large intestine with perianal involvement who underwent ileostomy in January, 1998 to July, 2009 in The State scientific center of coloproctology were included in original study. According to the spread of inflammatory process patients were distributed as follows: in 4 patients (9,3%) – proctosigmoiditis, in 15 (34,8%) – left-side lesion and in 24 (55,9%) – total involvement of the large intestine. Perianal lesions were presented by following types: ulcers-anal fissures – in 6 (14%) patients, rectal fistulas – in 12 (27,9%), strictures of anal canal – in 3 (6,9%), combinations of two and three types of perianal lesions were present in 22 (51,2%) patients. Results. Thirty five of 43 patients (81,3%) were monitored in terms from 1 to 12 months (М=5,5±2,6). Twenty four of 35 (68,5%) patients underwent local conservative treatment in period from 1 to 6 months (М=4,1±1,1), that provided healing in 11 cases to 2,8±1,4 month. Surgical treatment of perianal lesions was performed in 11 (31,5%) patients in terms from 2 to 12 months (М=5,9±3,6), healing was obtained in 9 patients on average up to 4,5±2,2 month in terms from 2 to 9 months.
Conclusion. At total involvement of the large intestine in combination to two and more types of the perianal lesions along with severe metabolic disorders, ileostomy should be applied as the first-line surgical treatment.
About the Authors
Yu. A. Shelygin
ФГУ «ГНЦ колопроктологии» Минздравсоцразвития России
Russian Federation
Russian Federation
V. N. Kashnikov
ФГУ «ГНЦ колопроктологии» Минздравсоцразвития России
Russian Federation
Russian Federation
K. V. Bolikhov
ФГУ «ГНЦ колопроктологии» Минздравсоцразвития России
Russian Federation
Russian Federation
A. V. Vardanyan
ФГУ «ГНЦ колопроктологии» Минздравсоцразвития России
Russian Federation
Russian Federation
I. L. Khalif
ФГУ «ГНЦ колопроктологии» Минздравсоцразвития России
Russian Federation
Russian Federation
References
1. Адлер Г. Болезнь Крона и язвенный колит. – М.: «Гэотар-Мед», 2001.
2. Белоусова Е.А. Биологическая стратегия в лечении воспалительных заболеваний кишечника // Фарматека. – 2006. – № 6. – C. 14–16.
3. Воробьев Г.И., Михайлова Т.Л., Фролов С.А. и др. Лапароскопическая илеостомия в лечении воспалительных заболеваний толстой кишки: Пособие для врачей, 2004.
4. Athanasiadis S., Girona J. Neue Behandlungsmethoden der perianalen Fisteln bei Morbus Crohn // Langenbecks Arch. Chir. – 1983. – Vol. 360. – S. 119–132.
5. Fammer R.G., Hawk W.A., Turnbull R.B. Clinical patterns in Crohn’s disease: a statistical of 615 cases // Gastroenterology. – 1975. – Vol. 68. – P. 627–635.
6. Fichera A., Michelassi F. Surgical treatment of Crohn’s disease // J. Gastrointest. Surg. – 2007. – Vol. 11, N 6. – P. 791–803.
7. Gordon P.H. Santhat Nivatvongs Principles and practice of surgery for the colon, rectum, and anus / 3rd ed., 2007.
8. Greenstein A.J., Sachar D.B., Greenstein R.J. et al. Intra-abdominal abscess in Crohn’s (ileo) colitis // Am. J. Surg. – 1985. – Vol. 143. – P. 27–37.
9. McClane S.J., Rombeau J.L. Anorectal Crohn’s disease // Surg. Clin. North Am. – 2001. – Vol. 81, N 1. – P. 169–183.
10. Michelassi F., Balestracci T., Chappell R. et al. Primary and recurrent Crohn’s disease. Experience with 1379 patients // Ann. Surg. – 1991. – Vol. 214. – P. 230– 238.
11. Michelassi F., Melis M., Rubin M., Hurst R.D. Surgical treatment of anorectal complications in Crohn’s disease // Surgery. – 2000. – Vol. 128, N 4. – P. 597–603.
12. Mueller M.H., Geis M., Glatzle J. et al. Risk of fecal diversion in complicated perianal Crohn’s disease // J. Gastrointest. Surg. – 2007. – Vol. 11, N 4. – P. 529–537.
13. Whiteford M.H., Kilkenny J., Hyman N. et al. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised) // Dis. Colon Rectum. – 2005. – Vol. 48, N 7. – P. 1337–1342.
Review
For citations:
Shelygin Yu.A., Kashnikov V.N., Bolikhov K.V., Vardanyan A.V., Khalif I.L. Efficacy of ileostomy in Crohn's disease of the large intestine with perianal involvement. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2011;21(6):64-68. (In Russ.)
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