Surgical Interventions in Inflammatory Bowel Disease

Abstract

INTRODUCTION: Abscesses, fistulas,hemorrhages and stenoses are common complications of inflammatory bowel diseases. This study provides an overview on various methods of radiological intervention and the clinical usefulness of these methods is analyzed. METHODS: The success rate of percutaneous abscess drainage (PAD), embolisation of hemorrhages and dilatation of bowel stenoses is reviewed and current literature is addressed. Success rate is defined in terms of cure rate and need for subsequent surgery. RESULTS: After PAD, surgery can be avoided during the observation period in about 50% of patients with abscesses due to Crohn's disease and diverticulitis. Preoperative PAD reduces the degree of invasiveness and thus the risk of surgery. Abscess recurrence is found with the same frequency following surgery or PAD. Bowel dilatation can be performed both with radiological and with endoscopic guidance.Embolisation of GI-hemorrhage is technically feasible, but the indication should be limited to strictly selected cases. CONCLUSIONS: In treating abscesses and fistulas associated with Crohn's disease and diverticulitis, PAD is a valuable treatment option. Embolisation or dilatation are restricted to rare cares.