Chiarello MM, Pepe G, Fico V, Bianchi V, Tropeano G, Altieri G, Brisinda G. Therapeutic strategies in Crohn’s disease in an emergency surgical setting. World J Gastroenterol 2022; 28(18): 1902-1921 [PMID: 35664965 DOI: 10.3748/wjg.v28.i18.1902]
Corresponding Author of This Article
Giuseppe Brisinda, MD, Professor, Surgeon, Department of Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. gbrisin@tin.it
Research Domain of This Article
Surgery
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 14, 2022; 28(18): 1902-1921 Published online May 14, 2022. doi: 10.3748/wjg.v28.i18.1902
Therapeutic strategies in Crohn’s disease in an emergency surgical setting
Maria Michela Chiarello, Gilda Pepe, Valeria Fico, Valentina Bianchi, Giuseppe Tropeano, Gaia Altieri, Giuseppe Brisinda
Maria Michela Chiarello, Department of Surgery, San Giovanni in Fiore Hospital, Azienda Sanitaria Provinciale di Cosenza, Cosenza 87100, Italy
Gilda Pepe, Valeria Fico, Valentina Bianchi, Giuseppe Tropeano, Gaia Altieri, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Giuseppe Brisinda, Department of Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Giuseppe Brisinda, Medical and Surgical Science, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Author contributions: Chiarello MM and Pepe G equally contributed to the drafting of the manuscript and both should be considered first author; Brisinda G and Chiarello MM designed the research; Bianchi V, Pepe G, Fico V, and Altieri G performed the research; Bianchi V and Fico V analyzed the data; Pepe G, Chiarello MM, Tropeano G, Fico V, Bianchi V, and Brisinda G wrote the paper.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Brisinda, MD, Professor, Surgeon, Department of Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. gbrisin@tin.it
Received: February 4, 2022 Peer-review started: February 4, 2022 First decision: February 24, 2022 Revised: February 28, 2022 Accepted: March 27, 2022 Article in press: March 27, 2022 Published online: May 14, 2022
Abstract
Crohn’s disease (CD) remains a chronic, incurable disorder that presents unique challenges to the surgeon. Multiple factors must be considered to allow development of an appropriate treatment plan. Medical therapy often precedes or complements the surgical management. The indications for operative management of CD include acute and chronic disease complications and failed medical therapy. Elective surgery comes into play when patients are refractory to medical treatment if they have an obstructive phenotype. Toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage represent indications for emergency surgery. These patients are generally in critical conditions and present with intra-abdominal sepsis and a preoperative status of immunosuppression and malnutrition that exposes them to a higher risk of complications and mortality. A multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care. Moreover, the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical operations. In this review, we aimed to discuss the acute complications of CD and their treatment.
Core Tip: Crohn’s disease remains a chronic and incurable disorder. Multiple factors must be considered to allow the development of an appropriate treatment. The indications for operative management of Crohn’s disease include acute and chronic disease complications and failed medical therapy. Progression into a complicated phenotype can be characterized by the formation of stenosis or abscesses/fistulas. Elective surgery comes into play when patients are refractory to medical treatment if they have an obstructive phenotype. Indications for emergency surgery include intestinal obstruction, abdominal and perineal sepsis, toxic colitis, or massive hemorrhage.
