PubMed · 8944472
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S W Atkinson, P G Bentley. 1996. Subcutaneous bridge support for defunctioning loop colostomy.. https://doi.org/10.1002/bjs.1800831042
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Crohn's disease is a relapsing systemic inflammatory disease, mainly affecting the gastrointestinal tract with extraintestinal manifestations and associated immune disorders. Genome wide association studies identified susceptibility loci that--triggered by environmental factors--result in a disturbed innate (ie, disturbed intestinal barrier, Paneth cell dysfunction, endoplasmic reticulum stress, defective unfolded protein response and autophagy, impaired recognition of microbes by pattern recognition receptors, such as nucleotide binding domain and Toll like receptors on dendritic cells and macrophages) and adaptive (ie, imbalance of effector and regulatory T cells and cytokines, migration and retention of leukocytes) immune response towards a diminished diversity of commensal microbiota. We discuss the epidemiology, immunobiology, amd natural history of Crohn's disease; describe new treatment goals and risk stratification of patients; and provide an evidence based rational approach to diagnosis (ie, work-up algorithm, new imaging methods [ie, enhanced endoscopy, ultrasound, MRI and CT] and biomarkers), management, evolving therapeutic targets (ie, integrins, chemokine receptors, cell-based and stem-cell-based therapies), prevention, and surveillance.
Filling the colon lumen with contrast allows for 3D-MR-colonography. The 3D data set can be postprocessed to multiplanar reconstruction, surface shaded displays as well as virtual colonoscopy. The latter facilitates the differentiation between haustra and polyps and enables detection of polyps down to 6 mm in size. Multiplanar reconstructions provide the assessment of the inner wall contour. The morphology of the colonic wall itself can be assessed on T1- or T2-weighted images. T1-weighted sequences performed before and after i.v. contrast administration and T2-weighted sequences depict pathologies based on their contrast uptake respectively on their tissue water content. This concept of colonic imaging practicable in less than 15 minutes is useful for the assessment of inflammatory disease, for polyp detection as well as for tumour staging.
We present herein the rare case of a patient who developed peritonitis due to colonic tuberculosis with perforation. The patient was successfully treated by resectional surgery with delayed restoration of bowel continuity and antitubercular therapy.