SURGICAL COMPLICATIONS IN CROHN'S DISEASE: PREVENTION AND TREATMENT. LITERATURE REVIEW

Abstract

Introduction: Crohn's disease is characterized by chronic inflammation of the gastrointestinal tract, which affects specific segments and all layers of the abdominal wall. It generally affects the end of the ileum and the initial portion of the colon, and can appear in different parts of the gastrointestinal tract. The cause of the disease is linked to the interaction between intestinal flora, mucosal damage and genetic factors. The incidence of the disease is increasing in industrializing countries and the most common symptoms are persistent diarrhea and pain in the lower right part of the abdomen, generally appearing between 20 and 40 years of age. The diagnosis is made clinically, supported by tests that show an increase in the erythrocyte sedimentation rate and C-reactive protein. Additionally, ileocolonoscopy reveals focal, irregular lesions in the gastrointestinal tract. Objective: Evaluation of research related to guidelines, surgical procedures, recurrence of injuries, risk factors for recurrence, general care and medical prevention after surgery for Crohn's disease. Technique: Bibliographic analysis based on 27 studies located in PubMed using the keywords "Crohn's disease", "surgical treatment" and "post-operative care", with English language filters, published in the last 20 years and studies of the type clinical trial, meta-analysis and systematic review. Results and discussion: Surgical treatment of Crohn's disease involves removing part of the intestine, reconstruction and dilation with an endoscopic balloon. Common reasons for removing part of the small intestine include cases of resistance to clinical treatment, perforation, obstruction, abscess, dysplasia and cancer. However, unfortunately, the disease can return in up to 90% of patients. Therefore, it is crucial to identify the risk factors associated with the patient, the disease and the surgery, in addition to following appropriate post-operative care. Generally, this involves the use of immunosuppressants such as glucocorticoids and immunomodulators such as an anti-TNF. In summary, it is critical to perform a risk assessment of patients to determine who will benefit from early medical treatment to prevent recurrence of Crohn's disease after surgery. In this sense, the experience of the medical team and the individual analysis of the case must guide the decisions made.