Open Ileocolic Presention Case Study
Open Ileocolic Resection
Presenting Complaint
Mrs. PC is a 56 year old woman who is 5 days post op following an open ileocolic resection indicated for a stricture in the terminal ilium on a background of Crohn’s disease.
History of presenting complaint
Patient has been suffering from Crohn’s disease since 1990 and has been attending the gastroenterology clinic since then. She has had recurrent pain in her right lower quadrant for approx. six months with four/five loose bowl movements per day, continually suffering from nausea, anorexia and she has also noted weight loss of 5 kgs in the last month. After a CT enterography and colonoscopy it was confirmed to be a stricture in the terminal ilium she was referred to the colorectal department for …show more content…
Half of all patients with CD will have complications such as strictures in the first 20 years of the disease.[1] the mechanism of stricture formation isn’t well understood, however it is widely accepted that stricture development ,since its CD is of Transmural nature, affects all layers of the bowel wall with histomorphological thickening, caused by ECM accumulation and mesenchymal cell expansion [2] Strictures associated with CD often lead to significant complications such as bowel obstruction and need intensive …show more content…
With CD patients more than 80% have at least one surgical resection within 10 years of their diagnosis.[2] Open ileocolic resection was performed in this patients case instead of the more widely used laparoscopic procedure because of the patients failed dilations and previous laparoscopic surgeries that an open procedure would minimise the risk of complications such as perforations. Also the patient does not have much small intestine remaining after the previous resections so laparoscopic would have been more difficult to perform. The surgeon made a midline incision from the umbilicus to the pubic bone then the right colon and ileum was mobilized. After vascular and bowel division, an end-to-side ileocolic anastomosis was performed. [3]
Alternative treatments would include the obvious Laparoscopic version. This is more routinely preformed however in a study it was shown that results from both methods are similar[3] however laparoscopic shows more favourable results in recovery time and cost of surgery. Strictureplasty is also another option for stricture in patients who have CD with previous surgeries. It is a useful surgical procedure for the CD strictures which could help in preserving intestinal length. [5] Strictureplasty has a 18% morbidity and 34% operative recurrence rates, which are comparative to the traditional
Presenting Complaint
Mrs. PC is a 56 year old woman who is 5 days post op following an open ileocolic resection indicated for a stricture in the terminal ilium on a background of Crohn’s disease.
History of presenting complaint
Patient has been suffering from Crohn’s disease since 1990 and has been attending the gastroenterology clinic since then. She has had recurrent pain in her right lower quadrant for approx. six months with four/five loose bowl movements per day, continually suffering from nausea, anorexia and she has also noted weight loss of 5 kgs in the last month. After a CT enterography and colonoscopy it was confirmed to be a stricture in the terminal ilium she was referred to the colorectal department for …show more content…
Half of all patients with CD will have complications such as strictures in the first 20 years of the disease.[1] the mechanism of stricture formation isn’t well understood, however it is widely accepted that stricture development ,since its CD is of Transmural nature, affects all layers of the bowel wall with histomorphological thickening, caused by ECM accumulation and mesenchymal cell expansion [2] Strictures associated with CD often lead to significant complications such as bowel obstruction and need intensive …show more content…
With CD patients more than 80% have at least one surgical resection within 10 years of their diagnosis.[2] Open ileocolic resection was performed in this patients case instead of the more widely used laparoscopic procedure because of the patients failed dilations and previous laparoscopic surgeries that an open procedure would minimise the risk of complications such as perforations. Also the patient does not have much small intestine remaining after the previous resections so laparoscopic would have been more difficult to perform. The surgeon made a midline incision from the umbilicus to the pubic bone then the right colon and ileum was mobilized. After vascular and bowel division, an end-to-side ileocolic anastomosis was performed. [3]
Alternative treatments would include the obvious Laparoscopic version. This is more routinely preformed however in a study it was shown that results from both methods are similar[3] however laparoscopic shows more favourable results in recovery time and cost of surgery. Strictureplasty is also another option for stricture in patients who have CD with previous surgeries. It is a useful surgical procedure for the CD strictures which could help in preserving intestinal length. [5] Strictureplasty has a 18% morbidity and 34% operative recurrence rates, which are comparative to the traditional