Chien B, Schulze-Delrieu K, Shirazi S S
Surg Gynecol Obstet. 1982 Oct;155(4):519-22.
Many patients with Crohn's disease have abdominal operations, but the role of surgical exploration in the recognition of this syndrome has not been assessed. We reviewed the operative records of 78 patients with a presumptive diagnosis of Crohn's disease who had a celiotomy between 1968 and 1979 at The University of Iowa Hospitals and Clinics. The patients were divided into two groups according to the likelihood of having Crohn's disease. Clinical presentation and operative indications were similar to those commonly reported for Crohn's disease. Most findings at celiotomy occurred with similar frequency in the two groups. Fat wrapping and thickening of the intestinal wall were the most common findings. These were closely followed in frequency of occurrence by the presence of adhesions, abdominal masses or serosal changes. Less common changes included strictures, intestinal dilation, skip lesions, fistulas and abscesses. Free peritoneal fluid and mesenteric lymph node enlargement were rare in 63 patients with established Crohn's disease but were comparatively more common in 15 patients deemed unlikely to have the disease. Even though the diagnosis of Crohn's disease was not firmly established preoperatively in more than one-fourth of the patients, the surgeon rarely took steps to make a specific diagnosis. Preoperatively, the diagnosis in four patients was changed from carcinoma of the cecum in two, from appendicitis in two and from ischemic colitis in one patient to a correct diagnosis of Crohn's disease, but never was a diagnosis preoperatively of Crohn's disease changed postoperatively to an alternative. We conclude that presently recognized operative findings are of limited value in the differential diagnosis of the disease because, in our experience, the preoperative diagnosis of Crohn's disease was never altered at operation. The diagnosis should be made with caution in the presence of free peritoneal fluid or mesenteric lymphadenopathy.
许多克罗恩病患者都接受过腹部手术，但手术探查在该综合征诊断中的作用尚未得到评估。我们回顾了1968年至1979年期间在衣阿华大学医院及诊所接受剖腹术、初步诊断为克罗恩病的78例患者的手术记录。根据患克罗恩病的可能性，将患者分为两组。临床表现和手术指征与克罗恩病常见报道相似。两组剖腹术中的大多数发现出现频率相似。脂肪包裹和肠壁增厚是最常见的发现。其次是粘连、腹部肿块或浆膜改变。较少见的改变包括狭窄、肠扩张、跳跃性病变、瘘管和脓肿。在63例确诊为克罗恩病的患者中，游离腹腔积液和肠系膜淋巴结肿大很少见，但在15例被认为不太可能患该病的患者中相对更常见。尽管超过四分之一的患者术前未确诊克罗恩病，但外科医生很少采取措施做出明确诊断。术前，4例患者的诊断从2例盲肠癌、2例阑尾炎和1例缺血性结肠炎改为正确的克罗恩病诊断，但术前诊断为克罗恩病的患者术后从未改为其他诊断。我们得出结论，目前公认的手术发现对该病的鉴别诊断价值有限，因为根据我们的经验，克罗恩病的术前诊断在手术中从未改变。在存在游离腹腔积液或肠系膜淋巴结病时应谨慎做出诊断。
