P382. Risk factors for a first abdominal surgical intervention in patients with already established diagnosis of Crohn's disease
R. Dudkowiak1, P. Petryszyn1, L. Paradowski1, 1Wroclaw Medical University, Department of Gastroenterology and Hepatology, Wroclaw, Poland
Crohn's disease is a chronic, idiopathic inflammatory bowel disease, in which the changes may affect to each section of the gastrointestinal tract, from the mouth to the anus. Crohn's disease can appear at any age, although it most commonly affects people in their second or third decade of life, and the frequency of its occurrence in recent years definitely increases. The essence of the changes in the gastrointestinal tract is a chronic, segmental, transmural inflammation, which can lead to complications such as intestinal stenosis or perforation where surgical intervention is inevitable. The aim of this study was to assess the risk factors of the primary abdominal surgery in patients with Crohn's disease.
We retrospectively analyzed a group of 162 patients (93 women, 69 men) with Crohn's disease hospitalized in our gastroenterology ward in 2010–2011. In this group 73 patients (45.1%) underwent surgery, including 44 patients (27.2%), surgery preceded the diagnosis of Crohn's disease. The analysis included age at diagnosis, sex, location of the lesions in the abdominal cavity and time from diagnosis to the treatment of Crohn's disease.
Surgery was performed in 19 women and 10 men (OR = 1.6). The mean age of women (32) was not significantly different from the mean age of men (mean 31) at the time of surgery. Therapeutic indications for surgery occurred between 4 months to 12 years from the time of diagnosis, usually between 2 and 5 years (mean 3.8 years). There were no statistically significant differences in the time interval from diagnosis to surgery among a group of women and men (p > 0.1). The most common causes of surgery were intestinal obstruction (82.7%) and intra-abdominal abscesses and fistulas. The most common location of inflammation tumors causing obstruction was region of terminal ileum and cecum (7 cases respectively). Obstruction at the level of the ascending, transverse, descending colon and rectum were observed a total of 7 patients (24%). In 3 patients similar changes were found in the small intestine. Fistulas and abscesses requiring surgical intervention occurred in 3 and 2 patients, respectively.
In the studied group 79% of the patients underwent surgery during the 5 years after the diagnosis of Crohn's disease. Gender was not a risk factor of operation both in the aspect of the age and the time from diagnosis to surgery. The most common reason for surgery was obstruction in the colon.