Crohn's Disease

Surgery

Many patients require surgery because medical therapy does not control their symptoms or because complications such as blockage, abscess, perforation or bleeding into the intestines have developed. Because symptoms may recur after surgery, patients must weigh the risks and benefits of the procedure. They should become educated through discussions with physicians, information from reputable organizations and others who have faced similar circumstances.

Resection

Probably the most commonly performed surgical procedure for Crohn's disease is surgical resection (removal of part of the intestine). The goal of surgery is to keep as much of the bowel as possible and to avoid a stoma (an opening in the abdomen used for eliminating waste). Following are the major kinds of resections:

• A segmental small bowel resection removes only the diseased portion of the small intestine.
• When a portion of the ileum is removed along with the cecum (a portion of the large intestine), the procedure is called an ileocolic resection with ileoascending colon anastomosis.
• When the colon is removed and the small intestine is joined to the nondiseased rectum, the procedure is called a subtotal colectomy or a total abdominal colectomy with ileorectal anastomosis (or ileorectostomy).
• A proctocolectomy is removal of the colon and rectum. After removal, an end-ileostomy (opening in the lower abdomen) is created. The patient wears a small bag over the opening (the stoma) to collect waste.

Severe inflammation throughout the intestine sometimes prevents immediate resection. In this case, a temporary ostomy is performed, in which a stoma is created to allow intestinal contents to drain out of the body into a collecting bag through the abdominal wall. The stoma is closed and the bowel reattached 12 weeks to 6 months after the initial surgery.

Strictureplasty

When possible, a procedure called strictureplasty is performed to widen a narrowing (stricture) in the small intestine. Because severe nutritional deficiencies can occur, it isn't advisable to remove long segments of small intestine. This surgery is performed in order to conserve the intestine and to improve the quality of life for people with mild to moderate Crohn's disease.

Abscesses and Fistulas

Approximately one in four adults with Crohn's disease have fistulas or abscesses. An abcess is a small area of infection. A fistula is an abnormal channel that is infected; it can drain outside the body or into the body. If a fistula perforates into the abdominal cavity, the infection tends to spread rapidly, causing severe pain, fever, shock, and bacteria in the blood. This situation becomes a surgical emergency, and an immediate abdominal exploration is performed in order to drain the abscess and wash out the abdominal cavity. A bowel resection and a temporary ostomy also may be required.