A NEW APPROACH IN THE MANAGEMENT OF CROHNS-DISEASE - OBSERVATIONS IN 20 CONSECUTIVE CASES

Although the ''modern history'' of Crohn's disease dates back to 1932, the etiology is still nebulous, the medical treatment inefficient and resective surgery results in. a high recurrence rate. Twenty consecut ive patients with terminal ileitis underwent ileo-cecal resection and mesenteric-epiploonplasty to enhance collaterals and lymphatic drainag e. This approach was advised by experimental observations (the ligatio n, of colonic Lymphatic ducts in rabbits), by the intraoperative use o f optics to better appreciate the details of the diseased bowel before and after injecting dye and by the angiographic results in one patien t. In rabbit experiments, the obliteration. of Lymphatic drainage led to Crohn's disease-like macroscopic and microscopic patterns, while di ffusion of the dye injected in, the diseased segment showed altered ly mph flow. The angiographic study in one patient confirmed the presence of vascular anomalies. Direct observation through optics revealed lar ge vessels in the serosa with milky contents and the oozing of sticky exudate. In the 8 patients who underwent this procedure over 5 years a go, there were no recurrences. We strongly believe in the vasculo-lymp hatic etiology of Crohn's disease and in, mesentery-epiploonplasty as the only actual indirect approach to resolve hemolymphatic obstruction s.