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Alimentary Tract| Volume 54, ISSUE 4, P490-499, April 2022

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Prevalence and significance of mesentery thickening and lymph nodes enlargement in Crohn's disease

  • Gianluca M. Sampietro
    Correspondence
    Corresponding author.
    Affiliations
    Division of General and HPB Surgery, ASST Rhodense Rho Memorial Hospital, Milan, Italy
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  • Giovanni Maconi
    Affiliations
    Division of Gastroenterology, ASST Fatebenefratelli Sacco, Milan, Italy

    Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy
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  • Francesco Colombo
    Affiliations
    Division of General Surgery, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Dario Dilillo
    Affiliations
    Children's University Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Paolo Fiorina
    Affiliations
    Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy

    Division of Endocrinology, ASST Fatebenefratelli Sacco, Milan, Italy

    Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA

    International Center for S1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy
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  • Francesca D'Addio
    Affiliations
    Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy

    International Center for S1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy
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  • Cristian Loretelli
    Affiliations
    Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy

    International Center for S1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy
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  • Cecilia Mantegazza
    Affiliations
    Children's University Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Manuela Nebuloni
    Affiliations
    Division of Pathology, ASST Fatebenefratelli Sacco, Milan, Italy
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  • Fabio Corsi
    Affiliations
    Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy

    Breast Unit, Surgery Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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  • Gianvincenzo Zuccotti
    Affiliations
    Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy

    Children's University Hospital, ASST Fatebenefratelli Sacco, Milan, Italy

    International Center for S1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy
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  • Sandro Ardizzone
    Affiliations
    Division of Gastroenterology, ASST Fatebenefratelli Sacco, Milan, Italy

    Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy
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  • Alberto Corona
    Affiliations
    Division of Anesthesiology, ASST Di Valle Camonica, Brescia, Esine, Italy
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  • Diego Foschi
    Affiliations
    Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Italy
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      Background

      Mesentery thickening and enlarged lymphnodes are typical findings of Crohn's disease (CD), but their role is unknown. Aim of the present study was to evaluate their prevalence and significance on postoperative complications and long-term surgical recurrence after CD surgery.

      Methods

      1272 consecutive, unselected patients were retrospectively reviewed, divided into 4 groups based on the presence or absence of a thickened mesentery and enlarged lymphnodes, and stratified for primary or recurrent surgical procedure. In all patients but those treated with strictureplasty the mesentery and lymphnodes were removed. Patients’ characteristics, peri-operative findings, and long-term recurrence were compared by univariate and multivariate analysis.

      Results

      Thickened mesentery and enlarged lymphnodes were not present in all cases, were typical of ileal location and penetrating behaviour, had a constant decrease over recurrences, were independent of either pre-operative medical therapy or surgical approach, did not increase the duration of surgery and complications, presented similar 20-years recurrence rate to normal mesentery and lymphnodes. Lymphopathy was associated to a worst nutritional status during disease recurrences. At multivariate analysis, age, location, and behaviour, but not mesenteric characteristics, were related to an increased risk of surgical recurrence.

      Conclusions

      This study provides new information on mesentery and lymphnodes in CD patients. Further studies are needed to clarify the appropriate surgical approach.

      Keywords

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