Surgical Experience of Crohn's Disease-A Single-Center 30-year Case Analysis

Abstract

Background. Crohn's disease is a relatively rare disease in Asian. An increasing incidence has been observed but domestic data for Crohn's disease was still lacking. The aim of this study was to assess the clinical course of Crohn's disease and the role of surgery in the treatment of Crohn's disease, in the intension to provide reference on clinical judgements. Methods. This study used data obtained from the Taichung Veterans General Hospital (VGHTC) Clinical Informatics Research and Development Center (CIRDC) database. The patients with diagnosis of Crohn's disease from 1984 to 2014 in VGHTC were screened. Sixty-four patients with Crohn's disease were identified and included in this study. Clinical records (age, location of the lesion and initial symptoms) and surgery records were reviewed for each patient. Results. The female/male ratio was 0.39:1, and the mean age at diagnosis was 37.73 years. Overall, the incidence peaked in those aged 21-30 years, with two peaks in the male patients and one peak in the female patients. In Montreal classification, L2 (37.5%) was the most common location of Crohn's disease, followed by L1, L3, and L4. Gastrointestinal bleeding was the most common clinical symptom (29.69%). In the initial diagnosis, 67.19% of the patients were diagnosed with other entities. Only 32.81% of the patients were proven to have or suspected of having Crohn's disease. 79.69% of the patients underwent surgery for a complication of Crohn's disease, 94.11% of whom underwent intestinal resection. 35.2% of the patients who underwent surgery required a second surgery within seven years. Conclusion. Due to the rarity of Crohn's disease in Taiwan, the diagnosis was often missed and most of the patients received surgery for late complications. Improved diagnostic modalities are needed to decrease the requirement for surgical interventions.