Surgery for Crohn’s Disease

What are the pros and cons of surgery for Crohn's disease? Here’s information you can use when talking to your doctor about treatment options for Crohn’s disease.

What Is Crohn's Disease?

Crohn's disease is a chronic illness in which the intestine, or bowel, becomes inflamed and marked with sores called ulcers. Along with ulcerative colitis, Crohn's disease is part of a group of diseases known as inflammatory bowel disease (IBD).

Crohn's disease most commonly affects the lower part of the small intestine, known as the ileum. But it can happen in any part of the large or small intestine, stomach, esophagus, or even the mouth. It can happen at any age, but it's most common between the ages of 15 and 30.

What Are the Symptoms of Crohn's Disease?

People with Crohn's disease have periods of severe symptoms. These are followed by periods with no symptoms when the disease is in remission. With Crohn's disease, remission can last for weeks or even years. But there is no way to know when a remission will happen or when symptoms will return.

The symptoms of Crohn's disease depend on where the disease occurs in the bowel. They also depend on how severe the disease is. In general, symptoms include:

  • Abdominal pain and tenderness -- often in the lower right section of the abdomen
  • Bloody stools
  • Chronic (long-term) diarrhea
  • Delayed development and stunted growth in children
  • Feeling of fullness in the abdomen, particularly in the lower right section
  • Fever
  • Weight loss

How Is Crohn's Disease Treated?

There is no cure for Crohn's disease. Treatment depends on the severity and location of the disease. Because the disease can sometimes go into remission on its own, it's not always possible to know whether a specific treatment has been effective.

When Crohn's disease is active, treatment has three objectives:

Medications are generally the first step in treating Crohn's disease. A partial list of these drugs includes:

For people with nutrition problems, doctors often prescribe supplements.

Two-thirds to three-quarters of people with Crohn's disease will eventually need surgery to treat their illness. There are several reasons why you might need surgery:

  • The medications are not working to control your symptoms or do not work well enough.
  • The drug side effects are unbearable.
  • You have serious complications that only surgery can correct.

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What Are the Complications of Crohn's Disease That Might Require Surgery?

People who have the following complications may need surgery:

  • The formation of a stricture (a scar), which is a narrowing in the bowel that can cause obstructions (blockages)
  • Extensive bleeding in the intestine
  • A hole, or perforation, in the bowel wall
  • The formation of a fistula, a connection between two parts of the body that do not normally connect
  • An abscess, a pocket of pus caused by infection
  • A condition known as toxic megacolon, in which the colon, or large intestine, is severely stretched out and toxins spread through your blood.

What Kinds of Surgery Are Performed to Treat Crohn's Disease?

Surgery to treat Crohn's disease depends on several things:

  • Where the disease is located in your intestines
  • How severe the disease is
  • The purpose of the surgery -- which complication it will treat

It's important to note that surgery, like medications, does not cure Crohn's disease. After the diseased part of the bowel is removed, Crohn's can reappear in some other part of your intestine or elsewhere.

Many people are wary of having surgery to treat Crohn's disease. Each part of the intestines serves a purpose, and removing part of the them may lead to diarrhea or malnutrition. Also, surgery is not for everyone. It is best to collect as much information as possible and to consult closely with your doctors to figure out the best possible treatment.

  • Strictureplasty. Crohn's disease in the small intestine often shows up in alternating areas of the bowel. As a result, a diseased portion of the bowel is connected to a disease-free portion. Strictureplasty is a surgical procedure to widen the narrow area of the small intestine in a portion that is affected by the disease. No part of the intestine is removed.
  • Resection. Resection is when part of the intestine is removed. This surgery may be necessary when the stricture is very long. It may also be necessary when there are many strictures near each other. The remaining healthy bowel sections are sewn together to create what's called an anastomosis. The removal of the diseased portion of the bowel may give you relief from symptoms for many years. But the disease can come back at or near the point where the two sections of bowel are sewn together.
  • Colectomy. Colectomy is the removal of the entire colon. This might be done if the disease is severe and extensive enough. It may be possible to connect the rectum to the small intestine -- ileum -- if the rectum is not affected by Crohn's disease.
  • Proctocolectomy. If both the rectum and colon are affected, both are removed with a surgery called a proctocolectomy. A proctocolectomy is performed along with an ileostomy. The ileostomy brings the end of the small intestine through a hole your surgeon makes in your lower abdomen so that waste can exit your body. The hole is called a stoma. When this procedure is necessary, the waste drains into an external bag that you empty throughout the day. The bag or pouch is concealed by clothing and is not noticeable.

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In about half of adults who have a resection to treat Crohn's disease, the disease recurs (comes back) within 5 years. The recurrence is normally near the site of the joining of two sections of healthy bowel -- anastomosis -- or at the site of the ileostomy.

The risk of recurrence may be lessened by taking medication to reduce inflammation. These medications include drugs that manipulate the immune system response. These drugs are known as immunomodulators r biologic medications.


. Often, recurrent Crohn's disease needs treatment that involves only medication. But about half of people who get recurrent Crohn's disease will need another operation.

If you develop a fistula or an abscess, you may need surgery. Fistulas, the abnormal passageways, may first be treated with medication. But if drugs do not help the fistulas to close, then you will need a bowel resection (removal of the problem area) and anastomosis (reconnection of the normal bowel).

In order to heal an abscess, the pocket of infection usually must be drained. You will have a computed tomography (CT) scan to let your doctor find the abscess. In some cases, the pus can be fully drained with a tube place through the skin. But in many cases, surgery is needed to treat the abscess.

WebMD Medical Reference Reviewed by Jaydeep Bhat, MD, MPH on February 14, 2019

Sources

SOURCES:

National Digestive Diseases Information Clearinghouse: "Crohn's Disease."

Crohn's & Colitis Foundation: "Surgery for Crohn's Disease."

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