Conservative surgical management of perforating Crohn's disease: side-to-side enteroenteric neoileocolic anastomosis: report of two cases

Conservative surgical management of jejunoileal Crohn's disease is the first-choice treatment in plurioperated patients with high risk of small-bowel syndrome. Treatment is more controversial in patients with a limited disease and no previous surgery, especially in those with terminal ileitis. Even in those cases we advocate conservative surgical management because we have demonstrated regression of both symptoms and morphologic lesions. Contraindications to nonresectional surgery include the presence of abscesses and fistulas. Impending short-bowel syndrome represents a partial exception to this approach. In this article two cases of conservative surgery performed in plurioperated patients with perianastomotic perforating recurrent disease are presented. We have named this procedure "side-to-side enteroenteric neoileocolic anastomosis," which is a combination of small resections and conservative procedure. This operative strategy leads us to believe that nonresectional surgery could be selectively performed even in patients with perforating Crohn's disease.