SURGICAL TREATMENTS OF THE

COMPLICATIONS OF INFLAMMATORY

BOWEL DISEASE

Maryam Treifi

Dr. Mircea Muresan

Faculty of Medicine, UMPh Targu MureșDepartment of Surgery Targu Mures County Hospital

INTRODUCTION IBD involves inflammation or ulceration in all or part of

the digestive tract. Two major forms of IBD are recognised:

• Crohn’s disease (CD), which can affect any part of the GI tract

• Ulcerative colitis (UC), which affects only the colon

Chronic inflammation impairs the ability of the affected organs to function properly, leading to symptoms such as abdominal cramping, alteration of bowel habits, rectal bleeding and fatigue. IBD can be debilitating and can sometimes lead to life-threatening complications.

AIMS AND OBJECTIVES The aim of the retrospective study was to analyse

how many cases of IBD complications had ended up in surgery and the type of procedure that was undertaken for each of two main diseases.

MATERIAL AND METHOD The retrospective study was conducted on records

of patients hospitalised after being operated on at the Surgery department of the County Hospital in Târgu Mureş between the years 2009-2015 to date.

The following factors were taken into consideration: age, sex, histopathology and the type of procedure carried out.

Data was collected and put into tables and charts using Microsoft Excel program.

EPIDEMIOLOGY Although both conditions have a worldwide

distribution, the highest incidence rates and prevalence have been reported from northern Europe, the UK and North America. Both race and ethnic origin affect the incidence and prevalence of Crohn’s Disease and Ulcerative Colitis.

Approximately 25% patients are diagnosed before their 25th birthday and there is increasing evidence that disease commencing in youth is more extensive and more aggressive than that occurring in older patients.

ETIOPATHOGENESIS

Exact cause is unknown

Genetic factors

Immunological

Microbial

Psychosocial

SURGICAL INDICATIONSCrohn’s Disease Failure of medical therapy, with acute or chronic symptoms producing

ill-health Complications (e.g. Toxic dilatation, obstruction, perforation,

abscesses, enterocutanous fistula) Failure to grow despite medical treatment Presence of perianal sepsis

Ulcerative Colitis Failure of medical treatment Toxic dilatation Haemorrhage Dysplasia Imminent perforation

ANALYSIS INTERPRETATION During the studied period, of the 25 diagnosed

patients, 21 had complications due to Ulcerative Colitis while 4 were due to Crohn’s.

The most affected age group was the 51-60, with a female predominant ratio of 1:0.19.

The most common procedure for Ulcerative Colitis were the enterectomies (50%) when in comparison to other procedures. In Crohn’s disease, the most common procedure undertaken was the right hemicolectomy (43%).

50%

17%

11%

11%

6% 6%

Ulcerative Colitis

enterectomyileostomysubtotal colectomysegment resectionright hemicolec-tomyrectal amputationinternal sphinc-terectomy

43%

29%

14%

14%

Crohn’s Disease

right hemicolec-tomy

internal sphinc-terectomy

enterectomy

segment resection

4%8%

36%

28%

20%4%

Age21-3031-4041-5051-6061-7071-80>80

CONCLUSION

Life with IBD can be challenging, however, it should not impede ones ability to live a normal life. Patients

with IBD can go to college, hold a normal job, get married, have children etc. As is the nature of any

chronic, unpredictable disease, there will be ups and downs.

The progress made in IBD research and treatment is astounding and will only improve in the years to come.

BIBLIOGRAPHYBooks Kumar and Clark. Clinical Medicine, eighth edition

2012 Longmore, Wilkinson, Davidson and Mafi. Oxford

Handbook of Clinical Medicine, eight edition 2010Websites Surgery for Crohn’s Disease and Ulcerative Colitis,

August 31st 2010, www.ccfa.org www. emedicine.medscape.com Centres for disease control and prevention,

www.cdc.gov/ibd

THANK YOU