Emergency surgery for inflammatory bowel disease in Greece

Abstract

In this study the various clinicoepidemiological features of
32 patients with inflammatory bowel disease (29 with
Crohn's disease and 3 with ulcerative colitis), who underwent
an emergency operation during a follow-up period of
15 years, are reviewed. The three patients with ulcerative
colitis who underwent an emergency operation, represent a
percentage of 0.7% of 413 patients seen and followed-up in
our institutions during the last 15 years, while the 29 patients
with Crohn's disease represent a percentage of 19%
of a total number of 155 patients diagnosed and followedup
during the same period. There were 18 men and 14 women
of mean age 4112 years. The indication for emergency
surgery in the group of patients with Crohn's disease was
obstructive ileus in 17, bowel perforation/peritonitis in 7,
and uncontrolled hemorrhage in 5 patients. The corresponding
indication for the group of patients with ulcerative colitis
was uncontrolled hemorrhage in two and toxic megacolon
in one patient. Obstructive ileus occurred in patients
with small bowel or ileocolonic involvement, uncontrolled
hemorrhage occurred mainly in patients with ileocolonic
involvement, while perforation occurred almost exclusively
in patients with small bowel involvement. Enterectomy
and end-to-end anastomosis was performed on 22 patients
with Crohn's disease while various other procedures were
performed in the remaining seven patients. Ileorectal anastomosis
was performed in one patient and total proctocolectomy
with permanent ileostomy in two patients with ulcerative
colitis. Two perioperative deaths were noticed in the
group of patients with Crohn's disease and one in the group
of patients with ulcerative colitis. Emergency operation for
inflammatory bowel disease is mainly needed for patients
with Crohn's disease. Clinicians must bear in mind that
perforation of the bowel could be the first manifestation in
a patient with Crohn's disease.
Key words: Crohn's disease, ulcerative colitis, surgery, emergency
operation, Greece