الفهرس 
Gastrointestinal tract surgical anatomyOnly 14 pages are availabe for public view
 |  | from | 252 |  |  |
| | | from | 252 | | |
Abstract
The term ‘inflammatory bowel disease’ (IBD) encompasses two major forms of chronic intestinal inflammations: Crohn’s disease and ulcerative colitis. Diagnosis and management of IBD is often not straightforward and requires specialist input. Crohn’s disease is an inflammatory disease that may affect any part of the gastrointestinal tract from mouth to anus causing a wide variety of symptoms but the ulcerative affect the colon only.
The highest rates of IBD are assumed to be in developed countries, and the lowest are considered to be in developing regions; colder-climate regions and urban areas have a greater rate of IBD than those of warmer climates and rural areas.
the combination and interaction of genetics(permissive, but they are not causative), environmental influences, and immunologic abnormalities may play the most important role,Population-based studies provided compelling evidence that genetic susceptibility plays an essential role in the pathogenesis of IBD.
The manifestations of inflammatory bowel disease (IBD) generally depend on the area of the intestinal tract involved. The commonly experienced symptoms of Crohn disease include recurrent abdominal pain and diarrhea. Sometimes, the diagnosis may be delayed by several months to a few years, as these symptoms are not specific for IBD. Patients with IBD have irritable bowel syndrome. Systemic symptoms are common in IBD and include weight loss, fever, sweats, malaise, and arthralgias. A low-grade fever may be the first warning sign of a flare. Patients are commonly fatigued. Children may present with growth retardation and delayed or failed sexual maturation. In 10-20% of cases, patients present with extraintestinal manifestations, including arthritis, uveitis, or liver disease. . However, in a small percentage of patients, the initial presentation can be of a fulminant nature.
There is no single test to confidently confirm or exclude the diagnosis of IBD. IBD is initially diagnosed on the basis of a combination of clinical, laboratory, histologic, and radiologic findings. Laboratory study results are generally nonspecific but may be helpful in supporting the diagnosis,Serologic studies have been proposed to help diagnose IBD and to differentiate Crohn disease from ulcerative colitis, but such studies are not recommended for routine diagnosis of Crohn disease or ulcerative colitis.Gastrointestinal Endoscopy and Biopsy.is The gold standard for the diagnosis of IBD. Gadolinium MRI (G-MRI) confirmed the diagnosis of either Crohn’s disease or ulcerative colitis, with a sensitivity and specificity of 96% and 92%, respectively,However, less invasive modalities, such as video capsule endoscopy, and advanced imaging, are being developed with improving sensitivity and specificity.
The goal of treatment of IBD is not only to induce remission of the active disease but also to prevent relapse. An individual treatment plan, based on type, severity and location of inflammation, age and psychological factors, is devised for each patient. Treatment may consist of one, or a combination of, nutritional treatment (or supplementation), drug therapy, biological therapy and possibly surgery.
Treatment of Crohn’s disease involves first treating the acute symptoms of the disease, then maintaining remission. Treatment initially involves the use of medications to eliminate infections, generally antibiotics, and reduce inflammation.
The rate of surgery in IBD has been decreasing, probably due to recent improvements in nutritional and medical treatment of the conditions.
Approximately 25%-35% of ulcerative colitis patients will ultimately require surgery (Urgent or elective) for either a complication of the disease or inadequate control of symptoms and it is acurative option.
whereas the goal in elective surgery is to remove all the colonic or dysplastic mucosa, the aim in emergent surgery is to rescue the patient from a life-threatening situation.
Urgent cases like Toxic megacolon refractory to medical management, Fulminant attack refractory to medical management, uncontrolled colonic bleeding, Perforation or Obstruction and stricture with suspicion for cancer.
A total abdominal colectomy with ileostomy and preservation of the rectum is the preferred operation for urgent condition., and it serves the main purpose of removing the diseased colon. This is particularly important in patients in whom the diagnosis is unclear and a subsequent ileoanal pouch might be contraindicated (e.g., in Crohn’s disease)
Total proctocolectomy in the urgent setting carries a prohibitively high mortality rate.
The presence of cancer may influence the procedure selected or the sequence of staged procedures. It does not exclude the possibility of performing an ileoanal pouch, but the location and stage of the cancer must be taken into consideration
Laparoscopic or hand-assisted laparoscopic surgery is feasible and safe in this situation. However, in critically ill patients, adopting laparoscopic surgery is controversial because this surgical procedure significantly increases the duration of the operation.