Anal carcinoma in patients with Crohn''s disease

Three patients with Crohn's disease and carcinoma of the anus are reported and compared to a group of patients with anal cancer and no inflammatory bowel disease. The three patients with Crohn's disease were relatively young women with significant perianal disease. There were two squamous cell lesions and one cloacogenic tumor in this group. The relative incidence of anal cancer as a proportion of all colorectal cancer, in patients with Crohn's disease (14%) was found to be significantly higher than the incidence of anal cancer in patients without inflammatory bowel disease (1.4%). Possible reasons for the increased incidence of anal cancer in Crohn's disease mentioned were: an overall increase in malignancies in inflammatory bowel disease, the high incidence of perianal disease, and the chronic long-standing perianal inflammation present. All patients with Crohn's disease, especially if they have active perianal disease, should be observed for the occurrence of anal cancer.     

Colorectal adenocarcinoma in Crohn''s disease.

OBJECTIVE: The authors' aim was to review the clinical features and estimate the long-term survival of patients with colorectal carcinoma complicating Crohn's disease. SUMMARY BACKGROUND DATA: Recent studies have demonstrated a significantly increased risk of colorectal carcinoma in patients with Crohns disease. METHODS: The authors reviewed retrospectively the medical records of 30 patients with Crohn's disease admitted to The Mount Sinai Hospital between 1960 and 1989 in whom colorectal adenocarcinoma developed. All patients were operated on and follow-up was complete for all patients to 10 years after operation, to the time of death, or to the closing date of the study in December 1989. RESULTS: The 30 patients in the series had 33 colorectal adenocarcinomas; three patients (10%) presented with two synchronous cancers. The patients were relatively young (mean age, 53 years) and had long-standing Crohn's disease (duration >20 years in 87%). The 5-year actuarial survival was 44% for the overall series: 100% for stage A, 86% for stage B, 60% for stage C. All five patients with excluded bowel tumor died of large bowel cancer within 2.4 years; by contrast, the actuarial 5-year survival for patients with in-continuity tumors was 56%. CONCLUSIONS: The incidence, characteristics, and prognosis of colorectal carcinoma complicating Crohn's disease are similar to the features of cancer in ulcerative colitis, including young age, multiple neoplasms, long duration of disease, and greater than a 50% 5-year survival rate (without excluded loops). These observations suggest the advisability of surveillance programs for Crohn's disease of the colon similar to those for ulcerative colitis of comparable duration and extent.     

Enterovesical fistulas in Crohn''s disease.

A total of 19 enterovesical fistulas were recorded in a series of 799 patients with Crohn's disease (2.4%). The origin of the fistulas was: ileum (9), colon (6) and four were complex involving the small and large bowel. Only 13 patients presented with urinary symptoms: pneumaturia (9), haematuria (1) and urinary tract infection (3). Four fistulas were identified incidentally during contrast radiology, one fistula was identified during a laparotomy and one further fistula developed after a previous resection for Crohn's disease. Four patients were managed conservatively and all are asymptomatic, but it is not known whether the fistula has healed. Twelve fistulas were resected: 9 healed, 2 recurred and 1 patient died following resection for a malignant fistula complicating Crohn's disease. Early in the series three patients were managed by bypass or defunction of the fistula. In all cases the sepsis persisted resulting in mortality. Persistent symptomatic fistulas should be treated by resection of the affected segment of bowel with primary anastomosis if appropriate. The defect in the bladder should be closed over an indwelling catheter which should not be removed until there is radiological confirmation that the bladder defect has healed satisfactorily.     

Prognostic significance of severe preoperative lymphopenia in patients with Crohn''s disease

Nearly 30% of patients with Crohn's disease requiring operative treatment have severe peripheral lymphopenia. The surgical significance of this finding had not been previously determined. One hundred fifty-eight patients with Crohn's disease admitted for resection of the diseased bowel were studied. Forty-six had preoperative peripheral lymphocyte counts under 1000 cells per mm3. Severely lymphopenic patients had a significantly higher incidence of skip areas and epithelioid granulomas than patients with higher lymphocyte counts. Also, lymphopenic patients were more likely to require separate resections of the diseased bowel and more than one anastomosis. Postoperative follow-up revealed that patients with preoperative lymphopenia had a markedly higher incidence of symptomatic recurrences within 3 years of operation (67 vs. 36%, p less than 0.01). It appears that the preoperative peripheral lymphocyte count may be used as an indicator of disease severity and prognosis in patients with Crohn's disease.     

单纯修补配合术后抑酸抗HP治疗在胃溃疡急性穿孔中的应用

目的 探讨单纯修补配合术后正规内科治疗对胃溃疡急性穿孔的意义.方法 对2003-2007年间收治的59例胃溃疡急性穿孔患者的临床资料进行回顾性分析.结果 59例均采用穿孔单纯修补术,手术均获得成功,无围手术期死亡,术后轻度并发症3例(5.1%),无再穿孔、大出血等严重并发症.术后给予奥美拉唑20 mg口服2次/天,疗程8～12周,若HP阳性同时服用阿莫西林1.0 g,克托霉素0.25 g均2次/天,疗程2周.随访54例,随访时间12～36个月,溃疡治愈率和复发率分别为98.1%(53/54)和3.8%(2/53).结论 单纯修补术后辅以正规内科疗法,是治疗胃溃疡急性穿孔的有效手段,可以考虑常规应用.     

Crohn''s disease of the appendix.

This study reports eight patients who underwent appendicectomy between 1978 and 1986 for apparently isolated, previously undiagnosed Crohn's disease of the appendix. All patients have since remained well with no sign of disease recurrence. This may represent a less aggressive form of Crohn's disease or be a different entity, namely granulomatous appendicitis.     

Hepatic abscess in patients with chronic granulomatous disease

OBJECTIVE: To evaluate the clinical presentation, diagnostic procedures, and surgical management of hepatic abscesses in patients with chronic granulomatous disease (CGD). SUMMARY BACKGROUND DATA: Chronic granulomatous disease is a rare inherited primary immunodeficiency in which phagocytes cannot destroy catalase-positive bacteria and fungi. Defects in the phagocytic cells' respiratory burst lead to life-threatening infections, including hepatic abscess. These abscesses are recurrent and often multiple and are treated differently from bacterial abscesses in patients without CGD. METHODS: Between 1980 and 2000, 61 cases of hepatic abscess in 22 patients with CGD were treated at the National Institutes of Health. Clinicopathologic features were investigated by retrospective review of the medical records, radiographs, and histopathology. RESULTS: Twelve of the 61 cases were primary hepatic abscesses. Twenty-nine of the cases were recurrent hepatic abscesses, and 20 cases were persistent hepatic abscesses. The median age at the time of initial hepatic abscess presentation was 14 years. Subjective fever was the most frequent presenting symptom, and the erythrocyte sedimentation rate was elevated in 98% of cases. Fifty-two cases were managed surgically and eight cases were managed with percutaneous drainage. One patient refused surgery. The surgical complication rate was 56%; however, there were no deaths directly related to the hepatic abscesses. Staphylococcus aureus was the most frequent organism identified in culture (88% of positive cultures). Aggressive surgery and antibiotics ultimately resulted in successful treatment of all patients. CONCLUSIONS: Hepatic abscesses occurring in patients with CGD represent a difficult diagnostic and treatment challenge. Early excision and treatment with antibiotics directed against S. aureus is necessary. General surgeons should be aware of this rare immunodeficiency and should aggressively manage hepatic abscesses in these patients.     

Jejunal Crohn''s disease is associated with a higher postoperative recurrence rate than ileocaecal Crohn''s disease

OBJECTIVE: Crohn's disease is a chronic inflammatory, panintestinal disease of uncertain aetiology. The recurrence rate of Crohn's disease, often taken as the time when further surgical procedure is undertaken, has been reported to be as high as 76% in 10 years. The site of the disease has not yet been associated with the recurrence rate of Crohn's disease. The aim of the study was to compare the outcome of patients who were surgically treated for jejunal Crohn's disease to those whose diseases was confined to the ileocaecal region. METHOD: The information was tracked from our database of 724 surgically treated Crohn's disease patients between 1943 and 2002. Twenty-eight patients with jejunal Crohn's disease at their first operation (12 jejunum alone, 16 also involving other sites) were identified. For each of these patients, 3 patients with ileocaecal Crohn's, matched for age, sex, and smoking habits (n = 84) were identified as controls. RESULTS: The median age in both groups was 21 years (range 16-52 years) with a median follow-up period of 19 years. The 3, 5 and 10 years re-operation rate for the groups with jejunal disease were 43%, 50% and 61% compared to 22%, 30% and 51% with ileocaecal disease, respectively. CONCLUSIONS: The presence of jejunal Crohn's disease is associated with a higher rate of early disease recurrence compared to ileocaecal disease but long-term recurrences rate do not differ significantly.     

Perinephric abscess in patients with polycystic kidney disease undergoing chronic hemodialysis.

5 patients with polycystic kidney disease undergoing chronic hemodialysis who developed perinephric abscesses are described. Gallium-67 scintigraphy was helpful in making a diagnosis in 2 of these patients. All 5 patients initially presented with urinary tract infections. Perinephric abscess became evident over a variable period of time (2--28 days) following completion of antibiotic therapy for their urinary tract infection. Gallium-67 scintigraphy appears useful in detecting this complication, and nephrectomy should be considered once the diagnosis is confirmed.     

Spontaneous perforation of the cervical esophagus.

A rare case of spontaneous rupture of the cervical esophagus occurred during vomiting after eating. The plain x-ray film showed air in the neck, but barium swallow did not reveal the perforation. Operation performed two days later because of bleeding consisted of suturing two rents in the anterior wall of the cervical esophagus distal to the cricopharyngeus muscle, and the patient did well. The mechanism causing such a perforation is not well understood. With the absence of bleeding, treatment would ordinarily consist of drainage without suture.     

小儿十二指肠特发性穿孔一例

小儿十二指肠特发性穿孔在临床上较为少见,其定义为不明原因所致的十二指肠穿孔。 临床资料 患儿,女,1(9/12)岁,入院因2001.9.13晚上10点钟无明显诱因下出现头面部风团样皮疹,伴面部肿胀,在当地医