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Necrotizing enterocolitis
194
Epidemiological Aspects of Crohn's Disease: A Review of the Literature. J.F. Mayberry and J. Rhodes. Gut 25:886
899, (August), 1984. A detailed literature review of the epidemiology of Crohn's disease is presented with the following conclusions: (1) the highest figures for Crohn's disease comes from northern Europe and North America; (2) Crohn's disease is more common in urban than in rural areas; (3) the incidence of Crohn's disease has definitely risen during the last 25 years in northern Europe; (4) there is no evidence for transmission or spread of an infective agent in the causation of Crohn's disease; (5) there is a small genetic predisposition to Crohn's disease that increases the risk of developing the disease by 30 in siblings and by 13 in all first-degree relatives; (6) the view that Crohn's disease is more common among Jews than other groups is based on small numbers and may not be true; (7) it is unlikely that fiber plays an important role in the development; (8) there is a higher sugar consumption in patients with Crohn's disease as compared with healthy controls, but this is probably a secondary factor rather than one of primary significance; (9) the standardized mortality ratio is twice normal in patients with Crohn's disease as compared to the normal population and is especially high in young patients or in those with extensive disease; (10) there is a slightly greater risk of a patient with Crohn's disease developing carcinoma.--Richard R. Ricketts Natural History of Recurrent Crohn's Disease at the IleocoIonic Anastamosis A f t e r Curative Surgery. P. Rutgeerts, K.
Geboes, G. Vantrappen, et al. Gut 25:665 672, (June), 1984. One hundred and fourteen patients who had been treated by a curative resection of the terminal ileum and part of the colon for Crohn's disease 1 to 10 years previously were studied endoscopically and histologically to evaluate the natural history of recurrent Crohn's disease. A diagnosis of recurrence was based on the presence of endoscopically demonstrable mucosal defects regardless of symptoms. The incidence of recurrence was 72% for patients examined within one year of the curative resection, 79% for patients examined 1 to 3 years after surgery, and 77% for patients examined between 3 and 10 years after surgery. No relationship was found between the presence of granulomas in the operative specimen or inflammatory changes in the cut margins of the operative specimen and the incidence of recurrence in any of the three groups. Also, the relationship between recurrence of symptoms and objective endoscopic evidence of recurrence was poor in that both symptoms and endoscopic mucosal defects were present in only 39% of patients. In 42% of the patients, there were endoscopic signs of recurrence without symptoms. Although the recurrence rate did not appear to increase over the years after the operation, the lesions became progressively more severe in the later phases. As the disease progressed, most patients developed rigid stenoses at their anastomosis. Richard R. Ricketts Long-term Prognosis of Crohn's Disease With Onset in Childhood and Adolescence. J. Puntis, A.S. McNeish, and
R.N. Allan. Gut 25:329-335, (April), 1984.
ABSTRACTS
Sixty-seven children with Crohn's disease whose symptoms started at or before 16 years of age were followed for a mean of 16.5 years after the onset of symptoms. Nearly all of the children presented with gastrointestinal symptoms, commonly associated with weight loss or growth retardation. Presentation with weight loss or growth retardation alone was rare. The largest group of patients, 38 (56%), presented with distal ileum and right colon disease. All but 2 of these patients were treated surgically at a mean interval between the diagnosis and resection of 1.7 years. The cumulative reoperation rate after an initial resection was 50% at 10 years. Eighteen children (27%) presented with colonic involvement only and 15 of these underwent surgical resection at a mean interval of 4 years between diagnosis and surgery. Approximately one half of the patients had an abdominal colectomy with an ileo-rectal or ileo-sigmoid anastomosis. The other half had a panproctocolectomy. Nine children (13%) presented with diffuse small bowel disease, but a total of 21% of the patients developed diffuse small bowel disease during follow-up. These patients pose the major problems in management, had the severest symptoms, developed major metabolic problems, and had the highest morbidity and mortality. Nine of the 67 children (13%) died. Thirty-eight of the 58 survivors are well with no evidence of recurrent disease, and 14 patients are well but with radiological evidence of residual disease. The authors note that although Crohn's disease carries a high morbidity and mortality, the long-term prognosis for most children is good with most survivors being well and leading productive l i v e s . Richard R. Ricketts Calcific Enterolith in a Vitello-lntestinal Duct. C.F.
Harvey
a n d J . M . Hood. Br J Surg 71:316, (April), 1984. The authors report a 32-year-old m a n presenting with abdominal pain, nausea, and vomiting. He had periumbilical tenderness and a history of a purulent umbilical discharge from 4 years of age until it ceased spontaneously at age 7. Medical advice was not sought at that time. Radiological examination revealed a 2 cm calculus lying in the midline anteriorly. At laparotomy a partially gangrenous patent vitello-intestinal duct containing a mass of toothpaste consistency was found. The authors believe this is the first such case report.--R.G. Buick Necrotizing Enterocolitis. R.M. Kliegman and A.A. Fanaroff. N Eng J Med 310:1093-1103, (April 26), 1984.
This is a review article describing the epidemiology, risk factors, role of infection, classification, treatment, outcome, and future considerations of nectrotizing enterocolitis. Detailed description of this review is beyond the scope of this abstract. This article is well written and provides an upto-date accounting of the present knowledge and status of necrotizing enterocolitis. Eugene S. Wiener Defective Complement Activation in Neonatal Necrotizing Enterocolitis. P. Purl, A. Lee, and D.J. Reen. Ann Paediatr
Surg 1:12-14, (January), 1984. In 9 neonates with perforation and peritonitis from necrotizing enterocolitis, serum immunoglobulins, complement
Epidemiological Aspects of Crohn's Disease: A Review of the Literature. J.F. Mayberry and J. Rhodes. Gut 25:886
899, (August), 1984. A detailed literature review of the epidemiology of Crohn's disease is presented with the following conclusions: (1) the highest figures for Crohn's disease comes from northern Europe and North America; (2) Crohn's disease is more common in urban than in rural areas; (3) the incidence of Crohn's disease has definitely risen during the last 25 years in northern Europe; (4) there is no evidence for transmission or spread of an infective agent in the causation of Crohn's disease; (5) there is a small genetic predisposition to Crohn's disease that increases the risk of developing the disease by 30 in siblings and by 13 in all first-degree relatives; (6) the view that Crohn's disease is more common among Jews than other groups is based on small numbers and may not be true; (7) it is unlikely that fiber plays an important role in the development; (8) there is a higher sugar consumption in patients with Crohn's disease as compared with healthy controls, but this is probably a secondary factor rather than one of primary significance; (9) the standardized mortality ratio is twice normal in patients with Crohn's disease as compared to the normal population and is especially high in young patients or in those with extensive disease; (10) there is a slightly greater risk of a patient with Crohn's disease developing carcinoma.--Richard R. Ricketts Natural History of Recurrent Crohn's Disease at the IleocoIonic Anastamosis A f t e r Curative Surgery. P. Rutgeerts, K.
Geboes, G. Vantrappen, et al. Gut 25:665 672, (June), 1984. One hundred and fourteen patients who had been treated by a curative resection of the terminal ileum and part of the colon for Crohn's disease 1 to 10 years previously were studied endoscopically and histologically to evaluate the natural history of recurrent Crohn's disease. A diagnosis of recurrence was based on the presence of endoscopically demonstrable mucosal defects regardless of symptoms. The incidence of recurrence was 72% for patients examined within one year of the curative resection, 79% for patients examined 1 to 3 years after surgery, and 77% for patients examined between 3 and 10 years after surgery. No relationship was found between the presence of granulomas in the operative specimen or inflammatory changes in the cut margins of the operative specimen and the incidence of recurrence in any of the three groups. Also, the relationship between recurrence of symptoms and objective endoscopic evidence of recurrence was poor in that both symptoms and endoscopic mucosal defects were present in only 39% of patients. In 42% of the patients, there were endoscopic signs of recurrence without symptoms. Although the recurrence rate did not appear to increase over the years after the operation, the lesions became progressively more severe in the later phases. As the disease progressed, most patients developed rigid stenoses at their anastomosis. Richard R. Ricketts Long-term Prognosis of Crohn's Disease With Onset in Childhood and Adolescence. J. Puntis, A.S. McNeish, and
R.N. Allan. Gut 25:329-335, (April), 1984.
ABSTRACTS
Sixty-seven children with Crohn's disease whose symptoms started at or before 16 years of age were followed for a mean of 16.5 years after the onset of symptoms. Nearly all of the children presented with gastrointestinal symptoms, commonly associated with weight loss or growth retardation. Presentation with weight loss or growth retardation alone was rare. The largest group of patients, 38 (56%), presented with distal ileum and right colon disease. All but 2 of these patients were treated surgically at a mean interval between the diagnosis and resection of 1.7 years. The cumulative reoperation rate after an initial resection was 50% at 10 years. Eighteen children (27%) presented with colonic involvement only and 15 of these underwent surgical resection at a mean interval of 4 years between diagnosis and surgery. Approximately one half of the patients had an abdominal colectomy with an ileo-rectal or ileo-sigmoid anastomosis. The other half had a panproctocolectomy. Nine children (13%) presented with diffuse small bowel disease, but a total of 21% of the patients developed diffuse small bowel disease during follow-up. These patients pose the major problems in management, had the severest symptoms, developed major metabolic problems, and had the highest morbidity and mortality. Nine of the 67 children (13%) died. Thirty-eight of the 58 survivors are well with no evidence of recurrent disease, and 14 patients are well but with radiological evidence of residual disease. The authors note that although Crohn's disease carries a high morbidity and mortality, the long-term prognosis for most children is good with most survivors being well and leading productive l i v e s . Richard R. Ricketts Calcific Enterolith in a Vitello-lntestinal Duct. C.F.
Harvey
a n d J . M . Hood. Br J Surg 71:316, (April), 1984. The authors report a 32-year-old m a n presenting with abdominal pain, nausea, and vomiting. He had periumbilical tenderness and a history of a purulent umbilical discharge from 4 years of age until it ceased spontaneously at age 7. Medical advice was not sought at that time. Radiological examination revealed a 2 cm calculus lying in the midline anteriorly. At laparotomy a partially gangrenous patent vitello-intestinal duct containing a mass of toothpaste consistency was found. The authors believe this is the first such case report.--R.G. Buick Necrotizing Enterocolitis. R.M. Kliegman and A.A. Fanaroff. N Eng J Med 310:1093-1103, (April 26), 1984.
This is a review article describing the epidemiology, risk factors, role of infection, classification, treatment, outcome, and future considerations of nectrotizing enterocolitis. Detailed description of this review is beyond the scope of this abstract. This article is well written and provides an upto-date accounting of the present knowledge and status of necrotizing enterocolitis. Eugene S. Wiener Defective Complement Activation in Neonatal Necrotizing Enterocolitis. P. Purl, A. Lee, and D.J. Reen. Ann Paediatr
Surg 1:12-14, (January), 1984. In 9 neonates with perforation and peritonitis from necrotizing enterocolitis, serum immunoglobulins, complement