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Positive Histological Inflammatory Margins Are Associated With Increased Risk for Intra-abdominal Septic Complications in Patients Undergoing Ileocolic Resection for Crohns Disease

Shental, Omri M.D.1; Tulchinsky, Hagit M.D.1; Greenberg, Ron M.D.1; Klausner, Joseph M. M.D.1; Avital, Shmuel M.D.2

doi: 10.1097/DCR.0b013e318267c74c
Original Contributions: Inflammatory Bowel Disease

BACKGROUND: Rates of postoperative complications are particularly high among patients with Crohn’s disease.

OBJECTIVE: The aim of this study was to assess whether positive inflammatory histological margins, among other factors, pose a risk for intra-abdominal septic complications in patients with Crohn’s disease undergoing ileocolic resection.

DESIGN: A retrospective study of patient records, during 2000–2010, was conducted.

SETTINGS: This investigation was performed at a single medical center.

PATIENTS: Included were 166 individuals with Crohn’s disease (85 males, mean age 35.6).

INTERVENTION: Ileocolic resection with primary anastomosis was performed.

MAIN OUTCOME MEASURE: The primary outcomes measured were postoperative intra-abdominal septic complications.

RESULTS: Twenty-five patients (15%) developed intra-abdominal septic complications, including anastomotic leak, intra-abdominal abscesses and collections, and enterocutaneous fistulas. There were no postoperative deaths. Univariate analysis revealed that a long course of disease before surgery, an emergency surgery, steroid treatment of more than 3 months before surgery, additional sigmoidectomy, and positive surgical margins detected on histopathological examination were associated with intra-abdominal septic complications. In a multivariate analysis, only disease duration longer than 10 years (OR 4.575 (CI 1.592–13.142), p = 0.005), additional sigmoidectomy (OR 5.768 (CI 1.088–30.568), p = 0.04), and positive histological resection margins (OR 2.996 (CI 1.085–8.277), p = 0.03) were found to be independent risk factors.

LIMITATIONS: This study was limited by the incomplete data regarding preoperative albumin levels.

CONCLUSIONS: Positive histological margins, disease duration of more than 10 years, and added sigmoidectomy are independent risk factors that are associated with postoperative intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn’s disease. These risk factors should be considered when the need for a diverting stoma is questionable. A frozen section of the margins may assist in the decision as to a temporary ileostomy construction.

1Department of Surgery, Tel-Aviv Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

2Department of Surgery B, Meir Medical Center, Kfar-Saba, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

Financial Disclosure: None reported.

Omri Shental and Hagit Tulchinsky contributed equally to this study.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

This work was performed in partial fulfillment of the M.D. thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University.

Correspondence: Shmuel Avital, M.D., Department of Surgery B, Meir Medical Center, 59 Tshernechovsky St, Kfar-Saba, Israel. E-mail:

© The ASCRS 2012