Enani Ghada N, Al Ghamdi Sarah S, Mimish Reem L, Farsi Ali, Butt Nadeem Shafique, Akeel Nouf
From the Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
From the Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Ann Saudi Med. 2025 May-Jun;45(3):182-189. doi: 10.5144/0256-4947.2025.182. Epub 2025 Jun 5.
The management of intra-abdominal fistulizing Crohn's disease involves surgical resection and biologic therapy. The criteria for choosing one therapy over the other are debated.
Identify factors influencing the choice of early surgical intervention over biologic therapy.
Retrospective.
Single center, tertiary training and research hospital.
We analyzed adult patients with Crohn's disease who had intra-abdominal fistulas and were followed for three years. Baseline data were collected from medical records, and imaging studies assessed the fistula type, number, affected segment length, and presence of strictures and abscesses. Multivariable logistic regression analysis was used to identify predictors for surgical intervention.
Factors that led to early surgical intervention in patients with intra-abdominal fistulizing Crohn's disease.
73 patients.
Seventy-three patients met the inclusion criteria: 27 (37.0%) in the nonsurgical group and 46 (63.0%) in the surgical group. Early surgical intervention was done if patients had bloating or constipation (=.018), extensive disease segments (<.001), and no prior biologic treatment (0.015). In the multivariate analysis, early surgical intervention was indicated for enterocutaneous fistulas (odds ratio [OR]: 8.20, 95% confidence interval [CI]: 1.25-53.80, =.03), abscesses (OR: 5.18, 95% CI: 1.03-26.12, =.046), and strictures (OR: 6.08, 95% CI: 1.26-29.25, =.024). Nonsurgical fistula treatment resulted in complications in 55% of patients, 48% of them requiring surgical resections, whereas biologic treatment achieved a 40.7% fistula healing rate.
Findings associated with Crohn's fistulas, including enterocutaneous fistulas, extensive disease segments, strictures, and abscesses, are associated with a higher likelihood of early surgical intervention and may suggest potential ineffectiveness of biologic therapies.
This was a retrospective analysis of a single center with a small sample size, which may involve a degree of recall bias when data are collected, thus reducing the reliability of the results.
腹腔内瘘管形成型克罗恩病的治疗包括手术切除和生物治疗。对于选择何种治疗方法存在争议。
确定影响早期手术干预而非生物治疗选择的因素。
回顾性研究。
单中心三级培训与研究医院。
我们分析了患有腹腔内瘘管的成年克罗恩病患者，并对其进行了三年的随访。从病历中收集基线数据，影像学研究评估瘘管类型、数量、受累肠段长度以及狭窄和脓肿的存在情况。采用多变量逻辑回归分析来确定手术干预的预测因素。
导致腹腔内瘘管形成型克罗恩病患者早期手术干预的因素。
73例患者。
73例患者符合纳入标准：非手术组27例（37.0%），手术组46例（63.0%）。如果患者出现腹胀或便秘（P = 0.018）、病变肠段广泛（P < 0.001）且未接受过生物治疗（P = 0.015），则进行早期手术干预。在多变量分析中，肠皮肤瘘（比值比[OR]：8.20，95%置信区间[CI]：1.25 - 53.80，P = 0.03）、脓肿（OR：5.18，95% CI：1.03 - 26.12，P = 0.046）和狭窄（OR：6.08，95% CI：1.26 - 29.25，P = 0.024）提示需要早期手术干预。非手术性瘘管治疗使55%的患者出现并发症，其中48%的患者需要手术切除，而生物治疗的瘘管愈合率为40.7%。
与克罗恩病瘘管相关的发现，包括肠皮肤瘘、病变肠段广泛、狭窄和脓肿，与早期手术干预的可能性较高相关，可能提示生物治疗潜在无效。
这是对单中心的回顾性分析，样本量较小，收集数据时可能存在一定程度的回忆偏倚，从而降低了结果的可靠性。
