Conservative surgical management of perforating Crohn's disease: Side-to-side enteroenteric neoileocolic anastomosis - Report of two cases

Conservative surgical management of jejunoileal Crohn's disease is the firs t-choice treatment in plurioperated patients with high risk. of small-bowel syndrome. Treatment is more controversial in patients with a limited disea se and no previous surgery, especially in those with terminal ileitis. Even in thous cases we advocate conservative surgical management because we hav e demonstrated regression of both symptoms and morphologic lesions. Contrai ndications to nonresectional surgery include the presence of abscesses and fistulas. Impending short-bowel syndrome represents a partial exception to this approach. In this article two cases of conservative surgery performed in plurioperated patients with perianastomotic perforating recurrent diseas e are presented, We have named this procedure "side-to-side enteroenteric n eoileocolic anastomosis," which is a combination of small resections and co nservative procedure. This operative strategy leads us to believe that nonr esectional surgery could be selectively performed even in patients with per forating Crohn's disease.