Lansdorp CA, Buskens CJ, Gecse KB, D'Haens GR, Van Hulst RA, et al.
United European gastroenterology journal. Date of publication 2020 Aug 1;volume 8(7):820-827.
1. United European Gastroenterol J. 2020 Aug;8(7):820-827. doi:
10.1177/2050640620934915. Epub 2020 Jun 12.
Wound healing of metastatic perineal Crohn's disease using hyperbaric oxygen
therapy: A case series.
Lansdorp CA(1), Buskens CJ(2), Gecse KB(3), D'Haens GR(3), Van Hulst RA(1).
Author information:
(1)Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam University
Medical Centre, Location AMC, Amsterdam, The Netherlands.
(2)Department of Surgery, Amsterdam University Medical Centre, Location AMC,
Amsterdam, The Netherlands.
(3)Department of Gastroenterology and Hepatology, Amsterdam University Medical
Centre, Location AMC, Amsterdam, The Netherlands.
Comment in
United European Gastroenterol J. 2020 Oct;8(8):970-971. doi:
10.1177/2050640620942433.
United European Gastroenterol J. 2020 Oct;8(8):972-973. doi:
10.1177/2050640620945090.
BACKGROUND: Metastatic Crohn's disease (CD) is a rare manifestation of CD. It
involves inflammatory skin lesions with histopathological findings (granulomas)
similar to CD, without connection to the gastrointestinal tract. Hyperbaric
oxygen therapy (HBO) has been suggested as a possible treatment option.
OBJECTIVE: This study aimed to identify and treat a consecutive series of
patients with biopsy-proven metastatic CD and monitor wound healing using
prospectively acquired outcomes.
METHODS: Pathology results of all patients with ongoing perineal wound-healing
problems after proctectomy between 2005 and 2018 at the Amsterdam University
Medical Centre were assessed for metastatic CD. Patients with a biopsy-proven
diagnosis of perineal metastatic CD were offered HBO (40 daily sessions of 100%
oxygen at 2.4 atmosphere absolute). Wound healing was monitored using
photographs and standardised questionnaires (the Inflammatory Bowel Disease
Questionnaire, EuroQol Visual Analogue Scale and the Female Sexual Function
Index) at baseline and 1 and 3 months after HBO.
RESULTS: Out of 13 patients in the cohort with persisting perineal wounds after
proctectomy, six (46%) had biopsy results consistent with metastatic CD. Of
these, three accepted treatment with HBO. All three patients were female. One
patient had complete healing of her perineal wound; another patient showed
initial improvement but had a flare of luminal and perineal disease at the
3-month follow-up. The third patient showed improvement solely in the
questionnaires, with higher scores on all three questionnaires.
CONCLUSION: A high rate of metastatic CD was found in patients with ongoing
wound-healing problems after proctectomy, implying that the disease might not be
as rare in these selected patients as previously thought. HBO might be
beneficial in the treatment of metastatic CD.
DOI: 10.1177/2050640620934915
PMCID: PMC7435003
PMID: 32529922 [Indexed for MEDLINE]
