The Predictive Value of Computed Tomography 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 computed tomography 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 computed tomography 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 computed tomography enterography index. RESULTS The incidence of postoperative intra-abdominal septic complications in patients undergoing a one-stage procedure was significantly higher than those undergoing a two-stage procedure (3/103 vs 24/241; 2.9% vs 10.0%; p=0.026). A multivariate analysis identified five computed tomography 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 five parameters was constructed. A receiver operating characteristic analysis identified a computed tomography enterography nomogram score cutoff of 175 as a predictor of intra-abdominal septic complications with a sensitivity of 83.3%, a specificity of 85.3%. In the prospective study, those patients with computed tomography enterography nomogram score greater than 175 were assigned to the two-stage group, which resulted in a similar intra-abdominal septic complications 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. CONCLUSION Preoperative computed tomography enterography findings may predict postoperative outcomes and help determine surgical approach in Crohn's Disease. Patients with worse intra-abdominal findings confirmed by computed tomography enterography may benefit from stoma creation after intestinal resection. See Video Abstract at http://links.lww.com/DCR/B588 .