P249. Cross sectional imaging techniques data compared to per-operative data in patients with Crohn's disease
N. Ben Mustapha, Y. Kardous, M. Serghini, A. Labidi, M. Fekih, J. Boubaker, A. Filali, La Rabta Hospital, Gastroenterology A, Tunis, Tunisia
Surgical indications in Crohn's disease (CD) should be carefully weighted and intestinal resection should be as short as possible. The operative indications rely, in large part, on the radiological assessment of disease.
The aim of this study was to compare cross sectional imaging techniques data to per-operative data in patients with CD and for whom surgery was indicated.
A retrospective analysis included among all CD patients for whom surgery was indicated between 2007 and 2012, only patients who have had their disease assessed by the mean of cross sectional imaging techniques: computed tomography (CT), computed tomography enterography (CTE), magnetic-resonance imaging (MRI) or magnetic resonance enterography (MRE). Imaging data were compared to those found per-operatively concerning location and length of disease, strictures, fistula and abscesses.
Forty-five patients were included. They were 26 women (58%) and 19 men (42%) with an average age of 33.4 years (14–64). The average time between disease diagnosis and surgery was 1.6 years. Disease location was colic in two cases, ileal in 26 cases and ileocolic in 17 cases. Eleven patients had structuring disease, 5 patients had penetrating and 29 had both. Surgery was indicated for symptomatic or complicated ileal stenosis in 41 cases, symptomatic colonic stenosis in 2 cases and for a diagnostic purpose in 2 cases. Pre-operatively, 15 patients had CTE, 24 had MRE, 5 had CT and one patient had MRI. The average time to surgery was 28.9 days. Cross sectional imaging data were consistent with per-operative data for the extent of disease in 35 patients (77%) and in 37 patients (82%) for stenosis. Regarding any fistula presence and their tracks, imaging data and per-operative observations gave similar results for 62% of cases. Cross sectional imaging had overestimated fistula in 12 patients, had not found per-operatively described fistula in 3 patients and had incorrectly described the fistula tracks in 3 patients.
In this study, cross sectional imaging data were not consistent with per-operative data in 53.33% of the cases. This discrepancy concerned mainly the fistula tracks description and the exact extent of disease.