Download PDF
Clin Colon Rectal Surg 2022; 35(04): 316-320
DOI: 10.1055/s-0042-1743589
Review Article

Role of the Mesentery in Crohn's Terminal Ileitis

Marte A.J. Becker
1   Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Eline M.L. van der Does de Willebois
2   Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
,
Willem A. Bemelman
2   Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
,
Manon E. Wildenberg
1   Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Christianne J. Buskens
2   Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

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 - mesentery - macrophages - ileocecal resection


Publication History

Article published online:
04 July 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis: a pathological and clinical entity. J Am Med Assoc 1932; 99 (16) 1323-1329 DOI: 10.1001/jama.1932.02740680019005. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 2 Gionchetti P, Dignass A, Danese S. et al; ECCO. 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 2: surgical management and special situations. J Crohn's Colitis 2017; 11 (02) 135-149 DOI: 10.1093/ecco-jcc/jjw169. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 3 Desreumaux P, Ernst O, Geboes K. et al. Inflammatory alterations in mesenteric adipose tissue in Crohn's disease. Gastroenterology 1999; 117 (01) 73-81 DOI: 10.1016/s0016-5085(99)70552-4. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 4 Peyrin-Biroulet L, Chamaillard M, Gonzalez F. et al. Mesenteric fat in Crohn's disease: a pathogenetic hallmark or an innocent bystander?. Gut 2007; 56 (04) 577-583 DOI: 10.1136/gut.2005.082925. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 5 Peyrin-Biroulet L, Gonzalez F, Dubuquoy L. et al. Mesenteric fat as a source of C reactive protein and as a target for bacterial translocation in Crohn's disease. Gut 2012; 61 (01) 78-85 DOI: 10.1136/gutjnl-2011-300370. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 6 Schäffler A, Schölmerich J, Büchler C. Mechanisms of disease: adipocytokines and visceral adipose tissue–emerging role in intestinal and mesenteric diseases. Nat Clin Pract Gastroenterol Hepatol 2005; 2 (02) 103-111 DOI: 10.1038/ncpgasthep0090. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 7 da Silva FAR, Pascoal LB, Dotti I. et al. Whole transcriptional analysis identifies markers of B, T and plasma cell signaling pathways in the mesenteric adipose tissue associated with Crohn's disease. J Transl Med 2020; 18 (01) 44 DOI: 10.1186/s12967-020-02220-3. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 8 Kredel LI, Batra A, Stroh T. et al. Adipokines from local fat cells shape the macrophage compartment of the creeping fat in Crohn's disease. Gut 2013; 62 (06) 852-862 DOI: 10.1136/gutjnl-2011-301424. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 9 Batra A, Heimesaat MM, Bereswill S. et al. Mesenteric fat - control site for bacterial translocation in colitis?. Mucosal Immunol 2012; 5 (05) 580-591 DOI: 10.1038/mi.2012.33. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 10 Randolph GJ, Bala S, Rahier JF. et al. Lymphoid aggregates remodel lymphatic collecting vessels that serve mesenteric lymph nodes in Crohn disease. Am J Pathol 2016; 186 (12) 3066-3073 DOI: 10.1016/j.ajpath.2016.07.026. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 11 Shen W, Li Y, Zou Y. et al. Mesenteric adipose tissue alterations in Crohn's disease are associated with the lymphatic system. Inflamm Bowel Dis 2019; 25 (02) 283-293 DOI: 10.1093/ibd/izy306. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 12 Yamamoto K, Kiyohara T, Murayama Y. et al. Production of adiponectin, an anti-inflammatory protein, in mesenteric adipose tissue in Crohn's disease. Gut 2005; 54 (06) 789-796 DOI: 10.1136/gut.2004.046516. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 13 Paul G, Schäffler A, Neumeier M. et al. Profiling adipocytokine secretion from creeping fat in Crohn's disease. Inflamm Bowel Dis 2006; 12 (06) 471-477 DOI: 10.1097/00054725-200606000-00005. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 14 van der Meer JHM, Wasmann KATGM, van der Bilt JDW. et al. Anatomical variation in mesenteric macrophage phenotypes in Crohn's disease. Clin Transl Gastroenterol 2020; 11 (08) e00198 DOI: 10.14309/ctg.0000000000000198. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 15 de Groof EJ, van der Meer JHM, Tanis PJ. et al. Persistent mesorectal inflammatory activity is associated with complications after proctectomy in Crohn's disease. J Crohn's Colitis 2019; 13 (03) 285-293 DOI: 10.1093/ecco-jcc/jjy131. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 16 Ha CWY, Martin A, Sepich-Poore GD. et al. Translocation of viable gut microbiota to mesenteric adipose drives formation of creeping fat in humans. Cell 2020; 183 (03) 666-683.e17 DOI: 10.1016/j.cell.2020.09.009. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 17 Coffey CJ, Kiernan MG, Sahebally SM. et al. Inclusion of the mesentery in ileocolic resection for Crohn's disease is associated with reduced surgical recurrence. J Crohn's Colitis 2018; 12 (10) 1139-1150 DOI: 10.1093/ecco-jcc/jjx187. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 18 Stevens TW, Haasnoot ML, D'Haens GR. et al; LIR!C study group. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: retrospective long-term follow-up of the LIR!C trial. Lancet Gastroenterol Hepatol 2020; 5 (10) 900-907 DOI: 10.1016/s2468-1253(20)30117-5. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 19 Luglio G, Rispo A, Imperatore N. et al. Surgical prevention of anastomotic recurrence by excluding mesentery in Crohn's disease: The SuPREMe-CD study - a randomized clinical trial. Ann Surg 2020; 272 (02) 210-217 DOI: 10.1097/SLA.0000000000003821. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 20 Kono T, Ashida T, Ebisawa Y. et al. A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn's disease. Dis Colon Rectum 2011; 54 (05) 586-592 DOI: 10.1007/DCR.0b013e318208b90f. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 21 Uchino M, Ikeuchi H, Matsuoka H, Matsumoto T, Takesue Y, Tomita N. Long-term efficacy of strictureplasty for Crohn's disease. Surg Today 2010; 40 (10) 949-953 DOI: 10.1007/s00595-009-4162-y. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar
  • 22 de Buck van Overstraeten A, Vermeire S, Vanbeckevoort D. et al. Modified side-to-side isoperistaltic strictureplasty over the ileocaecal valve: an alternative to ileocaecal resection in extensive terminal ileal Crohn's disease. J Crohn's Colitis 2016; 10 (04) 437-442 DOI: 10.1093/ecco-jcc/jjv230. [published Online First: Epub Date]|.
    CrossrefPubMedGoogle Scholar