Emergency Surgery

The indication for emergency surgery occurs in 1.6-10.4% of all cases of the disease, and carries a perioperative mortality rate of 2-40% [91,101-103].

Intraperitoneal abscess in Crohn's disease in most instances results from perforation or intestinal fistu-lae located in the small intestine. A large intestinal cause of abscess is most often a complication resulting from previous surgical procedure. In the case of elective procedures, the most likely cause lies in leakage of the anastomosis; in the case of emergency procedures, it results from peritonitis. Current advancement in invasive radiology makes transdermal drainage, in addition to traditional surgical drainage, possible. Transdermal drainage allows for the attainment of clinical improvement before indications for necessary surgical treatment arise. The disadvantages of transdermal drainage include the risk of fis-tulae and recurrent abscess; additional limitations come from technical inability in the transdermal drainage of some areas.

Obstruction in Crohn's disease is a frequent occurrence, but only 5-17% is caused by the pathological changes in a large intestine [104]. Obstruction may be caused by intra-abdominal abscess, intraperi-toneal adhesions, postinflammatory stenosis, or neo-plasmatic changes. It is necessary to perform diagnostic tests to search for the presence of tumours. Publications state that up to 7% of large-intestine obstruction in Crohn's disease is caused by cancer [104].

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