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P187. Outcomes of conservatively managed acute small bowel obstruction and predictors for subsequent surgery in Crohn's disease

F. Furfaro1, G. Maconi1, M. Monteleone1, C. Bezzio1, A. Friedman2, A. Dell'Era1, G.M. Sampietro3, S. Ardizzone1, R. De Franchis1, 1Gastrointestinal Unit – L. Sacco university Hospital, Clinical Sciences, Milan, Italy, 2The Alfred Hospital and Monash University, Department of Gastroenterology, Melbourne, Australia, 3Luigi Sacco University Hospital, Division of General Surgery II, Milan, Italy

Background

Stricturing Crohn's disease (CD) occurs in between 12% and 54% of the CD patient population and is associated with significant morbidity. Specific factors predicting the favourable outcome or need for surgery in CD patients, presenting with an acute bowel obstruction (ABO), are yet to be elucidated. The aim of this study was to identify predictors of recurrent obstruction and the subsequent need for surgery in CD patients presenting to an Emergency Department (ED) who were treated conservatively after an ABO.

Methods

The study included 66 consecutive CD patients presenting to the ED from 2007 to 2012 with an ABO, characterised by obstructive symptoms (abdominal pain and distension, nausea, vomiting, constipation and absence of flatus) and confirmed by abdominal x-ray and/or bowel ultrasound. The clinical course of patients who did not require surgery within 6 months after the acute episode was assessed, and factors related to recurrent obstructive symptoms and surgery were considered, taking into account several variables at ED presentation such as: gender, age, disease location, onset of disease, previous surgery, treatment of the acute episode, number of previous bowel obstructions and maintenance therapy. Statistical analysis was performed using Chi-square and Mann–Whitney tests.

Results

23 patients (35%) underwent surgery within 6 months and 43 patients (65%) were treated conservatively. Of these patients, 21 patients did not represent with another ABO, while 22 patients had at least one further episode of ABO and of these, 11 required a subsequent operation. There was no significant difference between groups regarding the following variables: length of follow-up (30.7 vs 28.1 months), gender, age, disease location, onset of disease, previous surgery, treatment of the acute episode and maintenance. Patients with recurrent symptoms had more internal fistulae (29.4% vs 0%, p: 0.044), a history of previous obstruction (90.9% vs 61.9%, p: 0.034) and a greater number of previous obstructive episodes (2.4±0.3 vs 1.33±0.28, p: 0.018). The number of obstructive episodes was also higher in patients who underwent a subsequent operation (2.8±0.5 vs 1.6±0.2; p: 0.025).

Conclusion

Approximately half the patients who were initially managed conservatively subsequently underwent surgery during a median follow-up of 2.5 years. Factors associated with recurrent obstructive symptoms and need for subsequent surgery are the presence of internal fistulae and a higher number of previous obstructions.