Werbin Nahum, Haddad Riad, Greenberg Ron, Karin Eliad, Skornick Yehuda
Department of Surgery A, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Isr Med Assoc J. 2003 Mar;5(3):175-7.
Free bowel perforation is one of the indications for emergency surgery in Crohn's disease. It is generally accepted that 1-3% of patients with Crohn's disease will present with a free perforation initially or eventually in their disease course.
To evaluate the incidence and treatment results of free perforation in patients with Crohn's disease and, based on our experience, to suggest recommendations.
Between 1987 and 1996, 160 patients with Crohn's disease were treated in our department and were followed for a mean period of 5 years.
Of the 83 patients (52%) requiring surgical intervention, 13 (15.6%) were operated due to free perforation. The mean age of the perforated CD was 33 +/- 12 years and the mean duration of symptoms prior to surgery was 6 years. The location of the free perforation was the terminal ileum in 10 patients, the mid-ileum in 2 patients, and the left colon in 1 patient. Surgical treatment included 10 ileocecectomies, 2 segmental resections of small bowel, and resection of left colon with transverse colostomy and mucus fistula in one patient. There was no operative mortality. Postoperative hospital stay was 21 +/- 12 days (range 8-55 days). All patients were followed for 10-120 months (mean 58.0 +/- 36.7). Six patients (42%) required a second operation during the follow-up period.
The incidence of free perforation in Crohn's disease in our experience was 15.6%. We raise the question whether surgery should be offered earlier to Crohn's disease patients in order to lower the incidence of free perforation.
游离性肠穿孔是克罗恩病急诊手术的指征之一。一般认为，1% - 3%的克罗恩病患者在疾病过程中最初或最终会出现游离性穿孔。
评估克罗恩病患者游离性穿孔的发生率及治疗结果，并根据我们的经验提出建议。
1987年至1996年期间，我科共治疗了160例克罗恩病患者，平均随访5年。
在83例（52%）需要手术干预的患者中，13例（15.6%）因游离性穿孔接受了手术。穿孔性克罗恩病患者的平均年龄为33±12岁，手术前症状的平均持续时间为6年。游离性穿孔的部位，10例位于回肠末端，2例位于回肠中部，1例位于左半结肠。手术治疗包括10例回盲部切除术、2例小肠节段性切除术，1例患者行左半结肠切除加横结肠造口术和黏液瘘。无手术死亡病例。术后住院时间为21±12天（范围8 - 55天）。所有患者均随访10 - 120个月（平均58.0±36.7）。6例（42%）患者在随访期间需要再次手术。
根据我们的经验，克罗恩病游离性穿孔的发生率为15.6%。我们提出一个问题，即是否应更早地为克罗恩病患者提供手术，以降低游离性穿孔的发生率。
