Emergências abdominais em pacientes com doença de Crohn: desafios no manejo cirúrgico e impacto clínico
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Resumo
Objetivo: A Doença de Crohn (DC) é uma inflamação crônica do trato gastrointestinal que pode exigir intervenção cirúrgica em casos graves. Este estudo visa entender os desafios no tratamento de emergências abdominais nestes pacientes, analisando os efeitos das cirurgias nos resultados clínicos e na qualidade de vida. Métodos: A revisão bibliográfica integrativa foi realizada na base PubMed Central, com 21 artigos selecionados. Resultados: O diagnóstico tardio da DC aumenta o risco de internações e cirurgias, dificultando o manejo. Alterações como a mioesteatose estão associadas a pior recuperação pós-operatória, enquanto o papel da sarcopenia é incerto. Métodos clínicos e de imagem são cruciais na escolha do tratamento, especialmente em casos de estenoses e fístulas. Embora as anastomoses primárias aumentem as complicações, estratégias em estágios reduzem recorrências. A excisão mesentérica ampliada não aumenta a morbidade. Cirurgias emergenciais, comuns na doença penetrante, aumentam o risco de complicações, exigindo cuidado individualizado. Considerações finais: O manejo cirúrgico das emergências abdominais na DC é desafiador e demanda abordagem multidisciplinar. O diagnóstico precoce, avaliação nutricional e o uso de modelos preditivos são essenciais para otimizar os desfechos. O avanço das técnicas cirúrgicas e terapias biológicas têm mostrado impactos positivos na morbimortalidade e qualidade de vida.
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Referências
2. BARKAI O, et al. Characterization of risk factors affecting the recurrence of perianal abscesses and complications. The Israel Medical Association Journal: IMAJ, 2024; 26(7): 428-433.
3. BARREIRO-DE ACOSTA M, et al. Epidemiological, clinical, patient-reported and economic burden of inflammatory bowel disease (ulcerative colitis and Crohn's disease) in Spain: a systematic review. Adv Ther., 2023; 40(5): 1975-2014.
4. BUNCE JA, et al. Urgency adjusted outcomes of emergency abdominal surgery for inflammatory bowel disease. World Journal of Surgery, 2024; 48(8): 1883-1891.
5. CAIAZZO A, et al. Increased postoperative use of computed tomography following emergency surgery for ileocaecal Crohn disease. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2020; 30(3): 214-217.
6. CELENTANO V, et al. High complication rate in Crohn's disease surgery following percutaneous drainage of intra-abdominal abscess: a multicentre study. International Journal of Colorectal Disease, 2022; 37(6): 1421-1428.
7. CELENTANO V, et al. The INTESTINE study: Intended Temporary Stomas in Crohn’s Disease. Protocol for an international multicentre study. Updates in Surgery, 2022; 74: 1691-1696.
8. CHIARELLO MM, et al. Therapeutic strategies in Crohn's disease in an emergency surgical setting. World Journal of Gastroenterology, 2022; 28(18): 1902-1921.
9. CONNELLY TM, et al. What is the real morbidity after emergency colectomy for Crohn's disease? A propensity score matched study. Tech Coloproctol., 2023; 27(4): 309-315.
10. DONNELLY M, et al. Obesity, sarcopenia and myosteatosis: Impact on clinical outcomes in the operative management of Crohn's disease. Inflammatory Bowel Diseases, 2024; 30(9): 1517-1528.
11. DUAN W, et al. Value of the Prognostic Nutritional Index in surgery for Crohn disease in China and the effects on outcome: A retrospective study. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2023; 33(3): 291-296.
12. HORENBLAS J, et al. The risk of stroke after prenatal exposure to famine. Journal of Developmental Origins of Health and Disease, 2017; 8(6): 658-664.
13. IGLESIAS B, et al. Resultados quirúrgicos a corto y mediano plazo por enfermedad de Crohn ileocecal. Revista Medica de Chile, 2022; 150(10): 1310-1316.
14. KODIA K, et al. Outcomes among malnourished patients with Crohn's disease undergoing elective ileocecectomy: A nationwide analysis. The American Surgeon, 2024; 90(4): 739-747.
15. KOOMSON D, et al. Making the cut? Reviewing the quality of surgical care in adults with Crohn's disease. British Journal of Hospital Medicine, 2024; 85(6): 1-4.
16. LAW CC, et al. Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease. The Cochrane Database of Systematic Reviews, 2020; 10(10): CD013256.
17. LIU RQ, et al. Comparison of primary anastomosis and staged surgery in emergency treatment of complicated Crohn's disease. J Dig Dis., 2020; 21(12): 724-734.
18. LIU W, et al. Temporal trends in surgery for Crohn's disease: a ten-year single-center retrospective study. International Journal of Colorectal Disease, 2023; 38(1): 221.
19. LOWE SC, et al. A clinical and radiographic model to predict surgery for acute small bowel obstruction in Crohn’s disease. Abdom Radiol (NY), 2020; 45(9): 2663-2668.
20. LUDWIG C, et al. Clinical and surgical factors for successful stoma reversal in patients with Crohn's disease-results of a retrospective cohort study. Int J Colorectal Dis., 2022; 37(10): 2237-2244. Erratum in: Int J Colorectal Dis., 2024; 39(1): 24.
21. NARDONE OM, et al. Impact of sarcopenia on clinical outcomes in a cohort of Caucasian active Crohn's disease patients undergoing multidetector CT-enterography. Nutrients, 2022; 14(17): 3460.
22. SCHINEIS C, et al. Microscopic inflammation in ileocecal specimen does not correspond to a higher anastomotic leakage rate after ileocecal resection in Crohn's disease. PLoS One, 2021; 16(3): e0247796.
23. TAJRA JBM, et al. Assessment of risk factors for surgery treatment of Crohn’s disease: A hospital cohort. ABCD Arq Bras Cir Dig, 2023; 36: e1730.
24. THIN LWY, et al. Ileocolonic end-to-end anastomoses in Crohn's disease increase the risk of early post-operative endoscopic recurrence in those undergoing an emergency resection. Journal of Gastrointestinal Surgery, 2021; 25(1): 241-251.
25. VERDALLE-CAZES M, et al. Abdominopelvic CT-scan in emergency departments for patients with suspected complications of Crohn’s disease: a single tertiary center experience. BMC Emergency Medicine, 2021; 21: 113.
26. VERMA A, et al. A simple emergency department based score predicts complex hospitalization in patients with inflammatory bowel disease. Digestive Diseases and Sciences, 2022; 67(2): 629-638.
27. WALKER GJ, et al. Quality improvement project identifies factors associated with delay in IBD diagnosis. Alimentary Pharmacology & Therapeutics, 2020; 52: 471-480.
28. WU E, et al. Patients with Crohn's disease undergoing abdominal surgery: Clinical and prognostic evaluation based on a single-center cohort in China. World J Surg., 2022; 46(2): 450-460.
29. ZABOT GP, et al. Surgical management of adult Crohn's disease and ulcerative colitis patients: A consensus from the Brazilian organization of Crohn's disease and colitis (GEDIIB). Arquivos de Gastroenterologia, 2023; 59(suppl 1): 1-19.