[
Abstract]
[
Full Text PDF] （in Japanese / 4271KB）
[Members Only And Two Factor Auth.] J.Jpn. Surg. Soc.. 81(7): 666-675, 1980
Original article
SURGICAL TREATMENT OF THE CROHN'S DISEASE WITH INTRAOPERATIVE INTESTINAL FIBERSCOPY
Eighteen patients with Crohn's disease operated upon in our clinic were studied clinicopathologically to investigate the etiology of postoperative recurrence. Primary involvements were located in ileum (8 patients), ileocolic region (7), colon (2) and unknown (1). There were characteristic longitudinal ulcers of 40ー70 cm in length in twelve patients. In those cases, “skip” lesions usually extended proximally to considerable extent. Most of the lesions developed as transmular inflammation were detected from the serosal surface. However, minute lesions such as aphtoid ulcers sometimes could not be detected from the serosal surface. Resection was performed in fifteen patients and in seven of them recurrence (recurrent rate 40%) occurred after an interval of 0.5-9 years (avarage 4.7 years). Resected specimens of the recurrent segment showed multiple rounded, annular or irregular-shaped ulcers, but there were no longitudinal ulcers in any of them. All lesions of the recurrences were located just proximal or distal to the anastomosis. These findings suggested that skip lesions might be left at the previous operation.
We have recently performed an intraoperative intestinal fiberscopy for the purpose of complete removal of the affected intestine. Among thirteen patients in whom the intraoperative fiberscopy was performed, four patients had skip lesions 10-50 cm apart from the lesion observed from the serosal surface. It was thought that intraoperative intestinal fiberscopy may be the valuable method for detection and decision of resection of the diseased intestine in Crohn's disease.
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