Therapeutic strategies in Crohn’s disease in an emergency surgical setting  

作　　者：Maria Michela Chiarello Gilda Pepe Valeria Fico Valentina Bianchi Giuseppe Tropeano Gaia Altieri Giuseppe Brisinda 

机构地区：[1]Department of Surgery,San Giovanni in Fiore Hospital,Azienda Sanitaria Provinciale di Cosenza,Cosenza 87100,Italy [2]Emergency Surgery and Trauma Center,Fondazione Policlinico Universitario A Gemelli IRCCS,Rome 00168,Italy [3]Department of Surgery,Fondazione Policlinico Universitario A Gemelli IRCCS,Rome 00168,Italy [4]Medical and Surgical Science,UniversitàCattolica del Sacro Cuore,Rome 00168,Italy

出　　处：《World Journal of Gastroenterology》2022年第18期1902-1921,共20页世界胃肠病学杂志（英文版）

摘　　要：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.

关 键 词：Crohn’s disease Intestinal obstruction Free perforation Intra-abdominal sepsis Perineal sepsis Acute bleeding 

分 类 号：R656.9[医药卫生—外科学]