Inflammatory bowel disease: diagnostic and therapeutic modalities

ABSTRACT

Inflammatory bowel disease [IBD] is chronic conditions of unknown origin that result from continuous or intermittent inflammation of a part of the intestinal wall. The main classic types of IBD are ulcerative colitis [UC], Crohn's disease [CD] and indeterminate colitis that cannot be classified accurately as UC or CD with pure colonic involvement. The aim of this study is to highlight this rare disease in our locality including; clinical feature, investigations, indication of surgical interference, operative procedures, histopathological examination, and postoperative complications. Twenty nine patients were included in this study from January 2000 to May 2006. Histopathological examination proved to be UC in 18 patients and CD of the intestinal tract in 11 patients. Patients were subjected to history, tarnsclinical examination, and routine laboratory investigation, abdominal X-ray in an erect position, barium enema, intravenous urography, sigmoidoscopy and colonoscopy. Biopsy was taken, and CT and MRI were done in selected cases. All patients subjected to medical and/or surgical treatment according to their finding. Their mean age was 49.4 +/- 2.1 years [range 12 -65 ys]. Female to male ratio was 21. The main clinical manifestations were abdominal pain in 27 patients [93.1%], bleeding per rectum in 14 patients [48.3%], mucus discharge in 10 patients [34.5%], and chronic diarrhea in 6 patients. Palpable abdominal mass was found in 3 patients. Extra-abdominal manifestations were loss of weight in 15 patients [51.7%], pallor in 11 patients [37.9%], lower limb edema in 7 patients and skin changes 4 patients. Twenty three patients [79.3%] were received medical treatment; 18 patients [62.1%] UC and 5 CD but the remaining 6 patients [20.7%] admitted to emergency department. Successful treatment with complete cure was achieved in 12 patients [41.4%]; 10 patients had UC and 2 CD while surgery was done in 17 patients [58.6%]; 9 patients had CD and 8 UC. Right hemicolectomy was done for 7 of them and limited resection anastomosis was performed in the other 2 patients. Total colectomy with terminal ileostomy was carried out in one patient and subtotal colectomy with ileorectal anastomsis in 7 patients. Postoperative intestinal fistula detected in one patient and right hemicolectomy was done. Wound infection occurred in 3 patients and one of them developed burst abdomen. IBD is not rare in our locality and its treatment still remains the challenge despite growing knowledge about the disease, advances in medical treatment and surgical techniques. Proper assessment of IBD requires cooperation of gastroenterologists, radiologists, histopathologists and surgeons