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MANAGEMENT OF ILEOCECAL CROHN’S DISEASE DURING SURGICAL TREATMENT FOR ACUTE APPENDICITIS: A SYSTEMATIC REVIEW

Authors :
Abel Botelho QUARESMA
Eron Fabio MIRANDA
Paulo Gustavo KOTZE
Source :
Arquivos de Gastroenterologia, Vol 58, Iss 4, Pp 560-565 (2021)
Publication Year :
2021
Publisher :
Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia (IBEPEGE), 2021.

Abstract

ABSTRACT BACKGROUND In many patients, the diagnosis of Crohn’s disease (CD) is made during surgery for appendicitis in urgent settings. Intraoperative diagnosis can be challenging in certain cases, especially for less experienced surgeons. OBJECTIVE: Review of the literature searching for scientific evidence that can guide surgeons through optimal management of ileocecal CD found incidentally in surgery for acute appendicitis (AA). METHODS: Included studies were identified by electronic search in the PubMed database according to the Preferred Items of Reports for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality and bias assessments were performed by Methodological Index for Non-Randomized Studies (MINORS) criteria for non-randomized studies. RESULTS: A total of 313 studies were initially identified, six of which were selected (all retrospective) for qualitative assessment (two studies were comparative and four only descriptive case series). Four studies identified a high rate of complications when appendectomy or ileocolectomy were performed and in only one, there was no increased risk of postoperative complications with appendectomy. In the sixth study, diarrhea, previous abdominal pain, preoperative anemia and thrombocytopenia were independent predictors for CD in patients previously operated for suspected AA. CONCLUSION: Despite the paucity of data and low quality of evidence, a macroscopically normal appendix should be preserved in the absence of complicated disease when CD is suspected in surgery for AA. Ileocecal resections should be reserved for complicated disease (inflammatory mass, ischemia, perforation or obstruction). Further prospective studies are needed to confirm these claims.

Details

Language :
English
ISSN :
16784219 and 00042803
Volume :
58
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Arquivos de Gastroenterologia
Publication Type :
Academic Journal
Accession number :
edsdoj.20f9b9cac8404ca9a59eefcf89470bf1
Document Type :
article
Full Text :
https://doi.org/10.1590/s0004-2803.202100000-98