Gastrointestinal Strictureplasty Techniques

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What is the likelihood of free perforation in patients with CD?

Around 5%

More than 15%

Approximately 10%

Less than 1% (correct)

What is the usual indication for urgent operation in cases of free perforation in CD?

Surgical resection with exteriorization (correct)

Antibiotic therapy

Nonoperative management

Percutaneous drainage

How is the diagnosis of free perforation in CD confirmed?

Identifying a sudden change in the patient's symptoms

Endoscopy and biopsy

Plain x-rays or CT scan showing free intraperitoneal air (correct)

Developing the physical findings of peritonitis

What is the consequence of successful drainage of an abscess in cases where a fistula persists?

Continued surgical resection Signup and view all the answers

What complication is likely to result from percutaneous drainage of an abscess?

Enterocutaneous fistula Signup and view all the answers

What is the main indication for urgent operation in the case of free perforation in patients with Crohn's disease?

Resection of the diseased segment and exteriorization of the proximal bowel Signup and view all the answers

Why is the index of suspicion for perforation higher in immunocompromised patients?

Immunosuppressants blunt the physical findings of acute perforation Signup and view all the answers

Why is creation of a primary anastomosis with a proximal protecting loop ileostomy avoided in free perforation cases?

It carries a high risk of anastomotic breakdown Signup and view all the answers

How is the diagnosis of free perforation confirmed?

By identifying free intraperitoneal air as demonstrated on plain x-rays or CT scan Signup and view all the answers

What is the rare complication of Crohn's disease occurring in less than 1% of patients?

Free perforation Signup and view all the answers

What is the result of the inflammatory response around the advancing sinus tract?

Adhesion to surrounding structures Signup and view all the answers

What is the main characteristic of a stricturing pattern of Crohn's disease?

Partial or complete intestinal obstruction Signup and view all the answers

What is typically accompanied by a degree of stricture formation in perforating Crohn's disease?

Fistula or abscess formation Signup and view all the answers

What is uncommon due to the inflammatory response around the advancing sinus tract in perforating Crohn's disease?

Free perforation with spillage of intestinal contents Signup and view all the answers

What dominates the clinical picture in cases of perforating Crohn's disease?

Fistula or abscess formation Signup and view all the answers

What is the characteristic feature of the perforating pattern of Crohn's disease?

Development of sinus tracts, fistulae, and abscesses Signup and view all the answers

How do patients with a perforating pattern of Crohn's disease typically present?

Primarily with obstructive symptoms Signup and view all the answers

Which of the following is NOT a feature of the perforating pattern of Crohn's disease?

Absence of fibrotic scar tissue Signup and view all the answers

What is the primary consequence of the sinus tracts in the perforating pattern of Crohn's disease?

Development of abscesses Signup and view all the answers

Which therapeutic option is often required for patients with a perforating pattern of Crohn's disease?

Surgical intervention Signup and view all the answers

Why should primary closure of perforation not be attempted in the case of diseased bowel?

Sutures cannot approximate the edges of the perforated, edematous, and diseased bowel in a satisfactory and tension-free way. Signup and view all the answers

What effect does distal intestinal stenosis or partial obstruction have on primary closure of perforation?

It causes an increase in the intraluminal pressure at the level of the local repair with subsequent dehiscence. Signup and view all the answers

Why is elective resection of areas of Crohn's disease recommended in cases of bleeding from the small bowel?

The risk of recurrent bleeding is high. Signup and view all the answers

What is a suggested risk factor for small bowel adenocarcinoma in patients with Crohn's disease?

Long-standing disease Signup and view all the answers

Why is the diagnosis of adenocarcinoma of the small bowel difficult in patients with Crohn's disease?

Symptoms and radiographic findings can be similar to those of the underlying CD. Signup and view all the answers

What is the most commonly performed strictureplasty for short segment strictures of 2-5 cm in length?

Heinecke-Mikulicz strictureplasty Signup and view all the answers

What type of strictureplasty can be used for strictures up to 15 cm in length?

Finney strictureplasty Signup and view all the answers

What is the potential risk associated with a very long Finney strictureplasty?

Functional bypass resulting in bacterial overgrowth Signup and view all the answers

What should be examined closely during the Heinecke-Mikulicz strictureplasty to rule out an uncommon complication?

Malignancy Signup and view all the answers

In essence, what kind of functional anastomosis is the Finney strictureplasty?

Short side-to-side functional anastomosis Signup and view all the answers

What is the best indirect evidence for the presence of an enterovesical fistula as noted on CT scan?

Presence of air within the bladder Signup and view all the answers

What is the controversy regarding surgical treatment of ileovesical fistulae?

The necessity for surgery Signup and view all the answers

What is the primary surgical requirement for the treatment of ileovesical fistulae?

Resection of the ileal disease Signup and view all the answers

Where do most ileovesical fistulas usually occur in the bladder?

Near the dome Signup and view all the answers

What is the reason for continuing decompression of the bladder postoperatively with a Foley catheter?

To reduce the risk of bladder dehiscence Signup and view all the answers

What is the purpose of a postoperative cystogram following surgical repair of a bladder defect?

To assess for leakage from the bladder repair Signup and view all the answers

In which patients do enterovaginal and enterocutaneous fistulas typically occur?

Patients with previous hysterectomy Signup and view all the answers

What is a potential risk associated with enterovesical fistulas if left untreated?

Progressive deterioration in renal function Signup and view all the answers

What does air within the bladder, as noted on CT scan, often indicate?

Presence of an ileovesical fistula Signup and view all the answers