1. Mechanisms of intestinal failure in Crohn's disease
- Author
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I. D. Anderson, M.H. Irving, A. O. Agwunobi, Gordon L Carlson, and N. A. Scott
- Subjects
Adult ,Male ,Short Bowel Syndrome ,Parenteral Nutrition ,medicine.medical_specialty ,Gastroenterology ,Statistics, Nonparametric ,Sepsis ,Crohn Disease ,Risk Factors ,Internal medicine ,medicine ,Humans ,Risk factor ,Aged ,Retrospective Studies ,Crohn's disease ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Short bowel syndrome ,Colorectal surgery ,Surgery ,Parenteral nutrition ,Female ,business ,Complication - Abstract
PURPOSE: The purpose of this study was to determine the mechanisms by which patients with Crohn's disease develop intestinal failure and, in particular, to assess the relative importance of severe primary disease, repeated uncomplicated elective small intestine resection, and resection performed as a consequence of intra-abdominal septic surgical complications. METHODS: This was a retrospective analysis of 41 patients with Crohn's disease referred to a specialized intestinal failure unit between January 1987 and September 1998 for permanent home parenteral nutrition. To compare the surgical activity in patient groups, a resection index was calculated by dividing the number of intestinal resections by the interval in years between the first resection for Crohn's disease and referral for management of intestinal failure. RESULTS: Extensive primary Crohn's disease was responsible for intestinal failure in 7 cases (17 percent). The remainder (n=34, 83 percent) developed intestinal failure after intestinal resection. Nine of the “surgical” Crohn's patients developed intestinal failure after uncomplicated sequential resection, (median small-bowel length 65 (range, 60–120) cm) after a median of 3 (range, 2–8) operations over a median of 17 (range, 3–27) years. By contrast, the other 25 surgical Crohn's patients developed intestinal failure after multiple unplanned laparotomies for intra-abdominal sepsis (median small-bowel length 70 (range, 60–200) cm), with a median of 4 (range, 2–7) laparotomies performed over a median of 0.5 (range, 0.1 to 1.5) years (P
- Published
- 2001