Crohn's Disease Treatment: Surgery
It is estimated that as many as 75% of people with Crohn's disease will
eventually require surgery during their lifetime. When
symptoms are not responding to medical therapy surgery is
used. Surgery is also used to correct complications of
Crohn's
disease including obstructions, bowel perforation, abscess, or
intestinal bleeding.
Surgery can not cure Crohn's disease, symptoms may and usually do
reoccur after surgery. Some patients require multiple
surgeries through
their lifetime. When inflammation does return it
tends to be the area next to where the diseased section was removed.
Because Crohn's disease can not be cured by surgery, patients need to
carefully weigh the benefits and risks with other treatments with their
doctor.
Resection
The most common surgical procedure for Crohn's disease is a resection.
A resection is
the removal of a section of the intestine. During a resection
the surgeon will keep as much of the bowel as possible, removing only
the
diseased portion and reattaching the healthy ends with a procedure
called an anastomosis.
There are times when the inflammation of the intestines is so severe
that an immediate resection can not be performed. When this
happens the surgeon creates a temporary ostomy. An opening,
or
stoma, is created to allow contents from the intestine to drain and
collect into a bag through the abdominal wall. The stoma is
eventually closed and the bowel reattached 3 to 6 months later.
Strictureplasty
A strictureplasty is a surgical procedure that widens a narrowing, or
stricture, of the small intestines. When possible this
procedure is used to preserve the intestines and relieve the symptoms
of mild to moderate Crohn's disease.
Fistula Repair and Abscesses
About 25% of those with Crohn's disease have fistulas or
abscesses. An abscess is a mass filled with pus from an
infection. A fistula is an abnormal channel that may drain
outside the body or into the body. Sometimes a fistula will
perforate the abdominal cavity, infections tend to spread
quickly. These infections cause server pain, fever, shock,
and
the release of dangerous bacteria into the blood. This
situation can become a surgical emergency. An immediate
exploratory surgery should be performed to locate and drain the abscess
as well as 'wash out' the abdominal cavity.
When fistulas do not respond to medical treatment surgery may be
required, most commonly a resection.
Abscesses can be drained by inserting a needle though the
skin. With the help of a CT scanner the needle is guided to
the correct location. Sometimes surgery is required to gain
access to drain the abscess.