Bowel Obstruction and Crohn's Disease

Medically Reviewed by Minesh Khatri, MD on June 17, 2022
4 min read

Blockage in your intestines is a common problem with Crohn’s disease. Crohn’s causes chronic, meaning ongoing, inflammation. This can thicken your intestinal wall, or make scar tissue from repeated swelling and healing. A stricture forms when the wall narrows.

Gas and waste material can build up and clog the confined opening. The blockage can keep food or stool from passing easily through your intestines.

Like a stricture, a fistula – an abnormal tunnel that can take shape in your intestinal walls – can lead to a partial or complete bowel obstruction.

Depending on how blocked the passage becomes, a stricture can range from mild to severe. Signs there may be some blockage include:

  • You feel nauseated or start vomiting.
  • Your stomach can get bloated.
  • Your belly might be making loud sounds.
  • You have sharp, cramp-like stomach pains. (These happen when normal bowel sections push against the stricture.)

Sometimes meds can reduce your swelling enough to ease the blockage. If the obstruction is severe, doesn’t respond to meds, or involves scar tissue, surgery might be needed. You’ll also likely need surgery if the condition happens often.

Half of people with Crohn’s disease will have fistulas or strictures within 20 years of diagnosis. Most will need surgery at some point.

Small bowel resection. This type of surgery removes the part of your small intestine that has the blockage or damage. Your surgeon can do this in two ways:

  • Laparoscopic. Your surgeon will use tiny instruments to make the smallest cuts needed. A laparoscope, which has a light and a camera on one end, will be slipped into a half-inch cut in your stomach. The images from inside your body will appear on a video monitor. The surgeon will insert mini-tools through the cuts and take out the blocked part of your small intestine. They’ll join the two healthy ends.
  • Open surgery. This will happen if your surgeon needs to make a larger cut. In this case, it’ll be about 6 inches long. They’ll remove the obstructed section and reconnect the normal ends.

Ileocecal resection. This surgery takes out the blocked part at the end of your small intestine, also known as the terminal ileum. The end of the small intestine and the tip of the colon are removed. The two healthy ends are joined.

Strictureplasty. This will widen the stricture without taking out any of the small intestine. Your surgeon will make a long cut lengthwise – vertically – along the narrowed area. Then they’ll sew it up crosswise so the segment is shorter and wider. A perk of this technique is that your surgeon can work on several strictures in one surgery.

Strictureplasty tends to work best in the lower parts of your small intestine. The downside is that it doesn’t always last. About half of people who have it will need another procedure down the road.

Subtotal colectomy. This is also known as a large bowel resection. It can remove a blocked part of your large intestine, aka the colon. The surgery can be done in the same ways as a small bowel resection, with laparoscopic or open surgery. With open surgery, the cut might need to be a little longer, up to 8 inches.

The benefits of a bowel resection, both in the large and small intestines, can last a long time. About half of people with Crohn’s will have a blockage recurrence within 5 years. The good news is, about 50% of cases where it happens again can be treated with meds instead of surgery. The other half will need a second surgery.

  • A possible complication of resection surgeries, where a part of the intestine is removed, is called short bowel syndrome. This happens if too much of your intestine is cut out. If this happens, the intestine might not be long enough to nourish your body as it should.
  • Chronic swelling, or expansion of an area near a stricture, can weaken your intestinal wall enough to open up a hole. This is called a perforation. It’s dangerous because it can let what’s in your intestine leak into your stomach. It can lead to a potentially deadly infection called peritonitis.
  • Swelling can happen in parts of your intestine that were near the blockage yet healthy at the time of surgery.

Surgery can’t usually cure Crohn’s. The goal is to keep as many healthy parts of your intestine as possible, try to prevent complications, and boost your quality of life.