Subscribe to RSS
DOI: 10.1055/s-0042-1743590
Intriguing Role of the Mesentery in Ileocolic Crohn's Disease
![](https://www.thieme-connect.de/media/ccrs/202204/lookinside/thumbnails/10-1055-s-0042-1743590_01150-1.jpg)
Abstract
Crohn's disease (CD) is a chronic relapsing inflammatory bowel disease with unknown etiology. Up to 80% of patients will eventually require surgery throughout their lifetime, and often repeated resections are required for disease recurrence. Observations of “creeping fat” surrounding the diseased intestine renewed interest in the mesentery, recently defined as an organ with endocrine and immune functions. According to the inside-out model, the mesentery may be primarily affected in CD and subsequent cause alterations in the mucosa. Recently, lower surgical recurrence rates have been reported with en-bloc excision of the mesentery adjoining the diseased intestine. Results of ongoing randomized controlled trials may clarify the role of the mesentery in CD and possibly lead to its adoption as standard during surgery for Crohn's disease.
Publication History
Article published online:
13 April 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Baumgart DC, Sandborn WJ. Crohn's disease. In: The Lancet. Vol 380. Elsevier B.V.; 2012: 1590-1605 DOI: 10.1016/S0140-6736(12)60026-9
- 2 Adamina M, Bonovas S, Raine T. et al. ECCO guidelines on therapeutics in Crohn's disease: surgical treatment. J Crohn's Colitis 2020; 14 (02) 155-168 DOI: 10.1093/ecco-jcc/jjz187.
- 3 Roda G, Chien Ng S, Kotze PG. et al. Crohn's disease. Nat Rev Dis Primers 2020; 6 (01) 22 DOI: 10.1038/s41572-020-0156-2.
- 4 Torres J, Bonovas S, Doherty G. et al. ECCO guidelines on therapeutics in Crohn's disease: medical treatment. J Crohn's Colitis 2020; 14 (01) 4-22 DOI: 10.1093/ecco-jcc/jjz180.
- 5 Yamamoto T, Lightner AL, Spinelli A, Kotze PG. Perioperative management of ileocecal Crohn's disease in the current era. Expert Rev Gastroenterol Hepatol 2020; 14 (09) 843-855 DOI: 10.1080/17474124.2020.1802245.
- 6 Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn's disease. Lancet 2017; 389 (10080): 1741-1755 DOI: 10.1016/S0140-6736(16)31711-1.
- 7 Shaffer VO, Wexner SD. Surgical management of Crohn's disease. Langenbecks Arch Surg 2013; 398 (01) 13-27 DOI: 10.1007/s00423-012-0919-7.
- 8 Rivera ED, Coffey JC, Walsh D, Ehrenpreis ED. The mesentery, systemic inflammation, and Crohn's disease. Inflamm Bowel Dis 2019; 25 (02) 226-234 DOI: 10.1093/ibd/izy201.
- 9 Weidinger C, Ziegler JF, Letizia M, Schmidt F, Siegmund B. Adipokines and their role in intestinal inflammation. Front Immunol 2018; 9: 1974 DOI: 10.3389/fimmu.2018.01974.
- 10 Weidinger C, Hegazy AN, Siegmund B. The role of adipose tissue in inflammatory bowel diseases. Curr Opin Gastroenterol 2018; 34 (04) 183-186 DOI: 10.1097/MOG.0000000000000445.
- 11 Mao R, Kurada S, Gordon IO. et al. The mesenteric fat and intestinal muscle interface: creeping fat influencing stricture formation in Crohn's disease. Inflamm Bowel Dis 2019; 25 (03) 421-426 DOI: 10.1093/ibd/izy331.
- 12 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.
- 13 Eder P, Adler M, Dobrowolska A, Kamhieh-Milz J, Witowski J. The role of adipose tissue in the pathogenesis and therapeutic outcomes of inflammatory bowel disease. Cells 2019; 8 (06) 628 DOI: 10.3390/cells8060628.
- 14 Gonçalves P, Magro F, Martel F. Metabolic inflammation in inflammatory bowel disease: crosstalk between adipose tissue and bowel. Inflamm Bowel Dis 2015; 21 (02) 453-467 DOI: 10.1097/MIB.0000000000000209.
- 15 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.
- 16 Galligan CL, Fish EN. The role of circulating fibrocytes in inflammation and autoimmunity. J Leukoc Biol 2013; 93 (01) 45-50 DOI: 10.1189/jlb.0712365.
- 17 Coffey JC, O'Leary DP, Kiernan MG, Faul P. The mesentery in Crohn's disease: friend or foe?. Curr Opin Gastroenterol 2016; 32 (04) 267-273 DOI: 10.1097/MOG.0000000000000280.
- 18 Coffey JC, Walsh D, Byrnes KG, Hohenberger W, Heald RJ. Mesentery - a ‘New’ organ. Emerg Top Life Sci 2020; 4 (02) 191-206 DOI: 10.1042/ETLS20200006.
- 19 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.
- 20 Coffey JC, O'Leary DP. The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 2016; 1 (03) 238-247 DOI: 10.1016/S2468-1253(16)30026-7.
- 21 Buskens CJ, Bemelman WA. Inclusion of the mesentery in ileocolic resection for Crohn's disease is associated with reduced surgical recurrence: editorial by Coffey et al. J Crohn's Colitis 2018; 12 (10) 1137-1138 DOI: 10.1093/ecco-jcc/jjy115.
- 22 Frühbeck G. Overview of adipose tissue and its role in obesity and metabolic disorders. Methods Mol Biol 2008; 456: 1-22 DOI: 10.1007/978-1-59745-245-8_1.
- 23 Andersen CJ, Murphy KE, Fernandez ML. Impact of obesity and metabolic syndrome on immunity. Adv Nutr 2016; 7 (01) 66-75 DOI: 10.3945/an.115.010207.
- 24 Siegmund B. Mesenteric fat in Crohn's disease: the hot spot of inflammation?. Gut 2012; 61 (01) 3-5 DOI: 10.1136/gutjnl-2011-301354.
- 25 Cardellini S, Socci C, Bissolati M. et al. Enrichment of Tc1 cells and T cell resistance to suppression are associated with dysglycemia in the visceral fat in human obesity. BMJ Open Diabetes Res Care 2020; 8 (01) 772 DOI: 10.1136/bmjdrc-2019-000772.
- 26 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.
- 27 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.
- 28 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.
- 29 Behr MA. The path to Crohn's disease: is mucosal pathology a secondary event?. Inflamm Bowel Dis 2010; 16 (05) 896-902 DOI: 10.1002/ibd.21171.
- 30 Ingallinella S, Campanelli M, Antonelli A. et al. The role of active inflammation and surgical therapy in Crohn's disease recurrence. Gastroenterol Res Pract 2020; 2020: 2845407 DOI: 10.1155/2020/2845407.
- 31 Heald RJ. The ‘holy plane’ of rectal surgery. J R Soc Med 1988; 81 (09) 503-508 DOI: 10.1177/014107688808100904.
- 32 Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis 2009; 11 (04) 354-364 , discussion 364–365 DOI: 10.1111/j.1463-1318.2008.01735.x.
- 33 Bertelsen CA, Neuenschwander AU, Jansen JE. et al. 5-year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study. Lancet Oncol 2019; 20 (11) 1556-1565 DOI: 10.1016/S1470-2045(19)30485-1.
- 34 Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis; a pathologic and clinical entity. Am J Med 1952; 13 (05) 583-590 DOI: 10.1016/0002-9343(52)90025-9.
- 35 Valibouze C, Desreumaux P, Zerbib P. Post-surgical recurrence of Crohn's disease: Situational analysis and future prospects. J Visc Surg 2021; 158 (05) 401-410 DOI: 10.1016/j.jviscsurg.2021.03.012.
- 36 Gklavas A, Dellaportas D, Papaconstantinou I. Risk factors for postoperative recurrence of Crohn's disease with emphasis on surgical predictors. Ann Gastroenterol 2017; 30 (06) 598-612 DOI: 10.20524/aog.2017.0195.
- 37 Simillis C, Jacovides M, Reese GE, Yamamoto T, Tekkis PP. Meta-analysis of the role of granulomas in the recurrence of Crohn disease. Dis Colon Rectum 2010; 53 (02) 177-185 DOI: 10.1007/DCR.0b013e3181b7bfb0.
- 38 Tandon P, Malhi G, Abdali D. et al. Active margins, plexitis, and granulomas increase postoperative Crohn's recurrence: systematic review and meta-analysis. Clin Gastroenterol Hepatol 2021; 19 (03) 451-462 DOI: 10.1016/j.cgh.2020.08.014.
- 39 Misteli H, Koh CE, Wang LM, Mortensen NJ, George B, Guy R. Myenteric plexitis at the proximal resection margin is a predictive marker for surgical recurrence of ileocaecal Crohn's disease. Colorectal Dis 2015; 17 (04) 304-310 DOI: 10.1111/codi.12896.
- 40 Nakao S, Itabashi M, Yamamoto T, Okamoto T. Predictive value of myenteric and submucosal plexitis for postoperative Crohn's disease recurrence. J Anus Rectum Colon 2018; 1 (02) 56-64 DOI: 10.23922/jarc.2016-006.
- 41 Milassin Á, Sejben A, Tiszlavicz L. et al. Analysis of risk factors - especially different types of plexitis - for postoperative relapse in Crohn's disease. World J Gastrointest Surg 2017; 9 (07) 167-173 DOI: 10.4240/wjgs.v9.i7.167.
- 42 Li Y, Ge Y, Gong J. et al. Mesenteric lymphatic vessel density is associated with disease behavior and postoperative recurrence in Crohn's disease. J Gastrointest Surg 2018; 22 (12) 2125-2132 DOI: 10.1007/s11605-018-3884-9.
- 43 Olaison G, Smedh K, Sjödahl R. Natural course of Crohn's disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut 1992; 33 (03) 331-335 DOI: 10.1136/gut.33.3.331.
- 44 Burke JP, Velupillai Y, O'Connell PR, Coffey JC. National trends in intestinal resection for Crohn's disease in the post-biologic era. Int J Colorectal Dis 2013; 28 (10) 1401-1406 DOI: 10.1007/s00384-013-1698-5.
- 45 Ewe K, Herfarth C, Malchow H, Jesdinsky HJ. Postoperative recurrence of Crohn's disease in relation to radicality of operation and sulfasalazine prophylaxis: a multicenter trial. Digestion 1989; 42 (04) 224-232
- 46 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.
- 47 Kono T, Fichera A, Maeda K. et al. Kono-S anastomosis for surgical prophylaxis of anastomotic recurrence in Crohn's disease: an international multicenter study. J Gastrointest Surg 2016; 20 (04) 783-790 DOI: 10.1007/s11605-015-3061-3.
- 48 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.
- 49 Wickramasinghe D, Warusavitarne J. The role of the mesentery in reducing recurrence after surgery in Crohn's disease. Updates Surg 2019; 71 (01) 11-12 DOI: 10.1007/s13304-019-00623-6.
- 50 Peltrini R, Bucci L. “Mesentery-based surgery” to prevent surgical recurrence in Crohn's disease: from basics to surgical practice. Int J Colorectal Dis 2019; 34 (02) 353-354 DOI: 10.1007/s00384-018-3197-1.
- 51 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.
- 52 Strong SA. Strictureplasty in complex Crohn's disease: beyond the basics. Clin Colon Rectal Surg 2019; 32 (04) 243-248 DOI: 10.1055/s-0039-1683905.
- 53 Bislenghi G, Ferrante M, Sabino J. et al. Short- and long-term outcomes following side-to-side strictureplasty and its modification over the ileocaecal valve for extensive Crohn's ileitis. J Crohn's Colitis 2020; 14 (10) 1378-1384 DOI: 10.1093/ecco-jcc/jjaa066.
- 54 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.
- 55 Li Y, Zhu W, Gong J, Shen B. The role of the mesentery in Crohn's disease. Lancet Gastroenterol Hepatol 2017; 2 (04) 244-245 DOI: 10.1016/S2468-1253(17)30036-5.
- 56 Li Y, Mohan H, Lan N. et al. Mesenteric excision surgery or conservative limited resection in Crohn's disease: study protocol for an international, multicenter, randomized controlled trial. Trials 2020; 21 (01) 210 DOI: 10.1186/s13063-020-4105-x.