INTESTINAL STENOSIS AND PERFORATING COMPLICATIONS IN CROHNS-DISEASE

The charts of 384 patients with Crohn's disease were reviewed to asses s the prognostic value of a bowel stenosis documented at the time of i nitial diagnosis for the occurrence of perforating (abscess, fistula, free perforation) or obstructing complications requiring surgical inte rvention. Mean follow-up was 5.6 years. At time of diagnosis a bowel s tenosis (S) was documented in 143 patients (37.2%). 130 patients under went surgery, 62 (48%) for obstruction, 18 (14%) for a perforating com plication, 12 (9%) for both obstructing and perforating complication a nd 38 (29%) for intractable disease. The cumulative rates of surgery w ere calculated using lifetable analysis. The presence of a stenosis at the time of initial diagnosis was a risk factor for the likelihood of surgery overall [65% (S) vs. 40% (no S) after 10 years; P<0.001] and of surgery for obstruction [70% (S) vs. 34% (no S); P<0.001] but did n ot increase the likelihood of a perforating complication [24% (S) vs. 29% (no S); n.s.]. A perforating complication requiring surgery may th erefore not be predicted by the mere diagnosis of a stenosis. Prophyla ctic surgery of stenotic lesions in patients with Crohn's disease to p revent the development of a perforating complication therefore is not recommended.