ABSTRACT
Background:Acute severe gastrointestinal bleeding is one of the severe complications of Crohn's disease (CD),and clinical data conceming its mechanism,characteristics and treatment are rare.Aims:To analyze the clinical characteristics and prognosis of acute severe gastrointestinal bleeding in CD.Methods:Clinical data of CD patients with acute severe gastrointestinal bleeding from January 2009 to April 2017 at Jinling Hospital were retrospectively analyzed,and the effect of various factors on rebleeding rate was analyzed.Results:Altogether 44 cases had acute severe gastrointestinal bleeding.Small intestine,ileocecum and anastomosis were the main bleeding sites,and 17 cases occurred with obscure bleeding site.History of enterectomy was found in 20 cases.Surgery was performed in 22 cases.Rebleeding occurred in 13 cases,including 11 cases within 1-year.No significant differences in rebleeding rate and 1-year rebleeding rate were found between patients received surgery and non-surgery treatment,patients with emergency surgery and selective surgery (P ＞0.05).Rebleeding rate was significantly lower in patients with bleeding site resected than in paitents with obscure bleeding stie (P ＜ 0.05),however,no significant difference in 1-year rebleeding rate was found betwwen the two groups (P =0.083).Conclusions:The incidence of acute severe gastrointestinal bleeding in CD is rather low,and the major bleeding sites are small intestine (among patients without enterectomy history) and anastomosis (among patients with enterectomy history).Surgery with bleeding site resected can decrease the recurrence of bleeding,which might be a protective factor for preventing rebleeding in CD patients.
ABSTRACT
<p><b>OBJECTIVE</b>To compare short-term outcomes of laparoscopic vs. open intestinal resection in patients with Crohn's disease (CD) under enhanced recovery after surgery(ERAS) program.</p><p><b>METHODS</b>Clinical data of 51 CD patients receiving laparoscopic surgery under ERAS program at our IBD center between January 2013 and March 2014 were retrospectively analyzed. Laparoscopic cases were matched to those undergoing open surgery from June 2011 to December 2012 with age, gender, location and behavior of disease. Intraoperative and postoperative data were collected.</p><p><b>RESULTS</b>Fifty-one laparoscopic cases were matched with 51 open cases. Laparoscopic group had a shorter median length of postoperative hospital stay (7 d vs. 9 d, P=0.034), shorter median time to first passage of gas(45 h vs. 59 h, P=0.024), shorter time to bowel movement(58 h vs. 76 h, P=0.018), less intraoperative estimated blood loss (35 ml vs. 75 ml, P=0.034) and longer median operative time (145 min vs. 105 min, P=0.003). Postoperative complications, reoperation and 30-day re-admission rates were similar and there was no mortality in the two groups.</p><p><b>CONCLUSION</b>Laparoscopic surgery is a safe and acceptable option for CD patients, and it promotes recovery of gastrointestinal movement and shortens postoperative hospital stay.</p>