Predictive Value Of Ct Enterography Index For Postoperative Intra-Abdominal Septic Complications In Patients With Crohn'S Disease: Implications For Surgical Decision-Making

BACKGROUND: Postoperative intra-abdominal septic complications in patients with Crohn's disease undergoing intestinal resection and anastomosis are frequent and difficult to manage.OBJECTIVE: This study sought to explore the value of preoperative CT enterography to predict intra-abdominal septic complications.DESIGN: This was a retrospective and prospective observational study.SETTINGS: This study was conducted in a tertiary referral hospital.PATIENTS: Patients with Crohn's disease undergoing primary intestinal resection were enrolled in our study.MAIN OUTCOME MEASURES: The CT enterography severity index was calculated and its ability to predict intra-abdominal septic complications evaluated by multivariate analyses. A prospective study was then performed to assess the reliability of this CT enterography index.RESULTS: The incidence of postoperative intra-abdominal septic complications in patients undergoing a 1-stage procedure was significantly higher than those undergoing a 2-stage procedure (3/103 vs 24/241; 2.9% vs 10.0%; p = 0.026). A multivariate analysis identified 5 CT enterography parameters, including mesenteric fibrofatty proliferation, intra-abdominal abscess or phlegmon, intestinal fistula, peritoneal effusion, and intestinal dilatation with stricture to be independent predictors of intra-abdominal septic complications (p < 0.001). A nomogram model based on these 5 parameters was constructed. A receiver operating characteristic analysis identified a CT enterography nomogram score cutoff of 175 as a predictor of intra-abdominal septic complications with a sensitivity of 83.3% and a specificity of 85.3%. In the prospective study, those patients with a CT enterography nomogram score >175 were assigned to the 2-stage group, which resulted in a similar intra-abdominal septic complication incidence in those undergoing intestinal resection with or without anastomosis (2/82 vs 2/34; p = 0.355).LIMITATIONS: This study was limited by its single-center scope.CONCLUSIONS: Preoperative CT enterography findings may predict postoperative outcomes and help determine surgical approach in Crohn's disease. Patients with worse intra-abdominal findings confirmed by CT enterography may benefit from stoma creation after intestinal resection.