Inflammatory Bowel Disease Emergency Management Clinical Practice Guidelines (WSES-AAST, 2021)

World Society of Emergency Surgery and American Association for the Surgery of Trauma

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

June 03, 2021

Clinical practice guidelines on the management of emergent inflammatory bowel disease by the World Society of Emergency Surgery and the American Association for the Surgery of Trauma were published in May 2021 in the World Journal of Emergency Surgery.[1]

Diagnosis

The following laboratory tests are recommended for assessing Crohn disease or ulcerative colitis in the urgent clinical situation: a full blood count, including hemoglobin, leukocyte count and platelet count; serum C-reactive protein level, erythrocyte sedimentation rate level, serum electrolytes, liver enzyme level, serum albumin, renal function, and fecal calprotectin level when possible. It is mandatory to exclude infectious disease by performing blood and stool cultures and toxin test for Clostridium difficile .

IV contrast-enhanced computed tomography is recommended to investigate the acute abdomen in IBD patients in the emergency setting to exclude intestinal perforation, stenosis, bleeding, and abscesses and to help guide decision making for immediate surgery or initial conservative management.

When computed tomography is not available, point-of-care ultrasonography is suggested to assess for free intra-abdominal fluid, intestinal distention, or abscess.

In stable patients with signs of GI bleeding, CT angiography is recommended to localize the bleeding site before angioembolization or surgery.

Treatment

It is recommended that antibiotics not be routinely administered to IBD patients but, rather, only in the case of superinfection, intra-abdominal abscess, and sepsis.

Antifungals should be reserved for high-risk patients, such as those who have a bowel perforation or who have recently received steroid treatment.

Venous thromboembolism prophylaxis is recommended as soon as possible with low-molecular-weight heparin (LMWH) because of the high risk of thrombotic events related to complicated IBD in the emergency setting.

It is recommended that patients be weaned off steroids (preoperatively, ideally 4 weeks) and stop immunomodulators associated with anti-TNF-α agents before surgery to decrease the risk of postoperative complications.

Emergency surgical exploration is recommended in hemodynamically unstable patients. Subtotal colectomy with ileostomy is the surgical treatment of choice in patients with acute severe ulcerative colitis, patients with massive colorectal hemorrhage, or nonresponders to medical treatment.

For more information, please go to Inflammatory Bowel Disease.

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