Role of the Mesentery in Crohn's Terminal Ileitis

Abstract

Despite the longstanding awareness of the presence of mesenteric alterations in Crohn's disease, the functional and clinical consequences of these alterations remain a topic of debate. Guidelines advise a limited resection without resection of the adjacent mesentery to prevent short bowel syndrome and postoperative complications. However, recently mesenteric resection has been proposed as an alternative to reduce recurrence rates in Crohn's disease patients. Here, we evaluate the data available on this topic in terminal ileitis, both from a fundamental research point of view and clinical perspective.

Keywords: Crohn's disease; ileocecal resection; macrophages; mesentery.

Fig. 1

Mesenteric macrophages show a remodeling phenotype near the creeping fat. ( A ) CD163 ⁺ /CD163 ⁻ ratios in the ileocecal region of patients with Crohn's disease with terminal ileitis ( n  = 20). Mesentery samples from 3 different locations: creeping fat, resection margin and more centrally. ( B ) CD163 ⁺ /CD163 ⁻ ratios in patients with active ( n  = 1), penetrating ( n  = 6), and stenotic ( n  = 13) disease. Bars represent means, error bars represent SEM. * p  < 0.05. ** p  < 0.01. Calculated by t -test.

Fig. 2

Postoperative specimen of ileocecal resection in Crohn's disease patients. ( A ) Postoperative specimen following conventional ileocecal resection. ( B ) Postoperative specimen following ileocecal resection with inclusion of the mesentery.