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Surgical Management of Crohn’s Disease

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Crohn's Disease

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Abstract

The most common location for Crohn’s disease (CD) is the ileo-colic region, with isolated disease in the small bowel or colon occurring less frequently. Peri-anal Crohn’s is usually found in combination with disease at other sites, especially the distal large bowel. The site of disease tends to remain stable over time, whilst the type of disease often evolves into stenosing (stricturing) or penetrating (fistulating) forms.

Advances in medical management have improved remission rates, resulting in fewer early surgical interventions. Most patients do require surgery during the course of the disease, often after an initial period of medical management.

Patients with ileo-colic CD that is poorly controlled on medical treatment need surgical resection, usually for recurrent obstruction, septic or fistula related complications. Laparoscopic surgery when feasible is a preferred option. Despite the advances in medical management, there is a role for early surgery in selected patients. Recurrent ileo-colic disease is common, which may warrant further surgery.

Isolated or multi-site small bowel CD may be treated surgically by strictureplasty, which is effective and preserves bowel length. Obstructing or symptomatic large bowel disease can be treated with segmental resection or colectomy and ileo-rectal anastomosis, but severe pancolitis, distal disease or dysplastic/neoplastic disease may need procto-colectomy. Those with anal Crohn’s often need initial simple intervention comprising antibiotics, surgical drainage and seton insertion to control anal sepsis. Medical treatment after control of sepsis improves long-term results. Severe fistulating, complex, septic, ulcerating or stenosing disease, especially in the presence of rectal disease, may need defunctioning or procto-colectomy.

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Authors and Affiliations

  1. Department of Surgery, South Warwickshire Foundation NHS Trust, Warwick, CV34 5BW, England, UK

    Paul D. Murphy PhD, FRCS & Trif Papettas

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  1. Paul D. Murphy PhD, FRCS
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  2. Trif Papettas
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Correspondence to Paul D. Murphy PhD, FRCS .

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  1. University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

    Arumugam Rajesh

  2. Department of Radiology, Warwick Hospital, Warwick, United Kingdom

    Rakesh Sinha

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Murphy, P.D., Papettas, T. (2015). Surgical Management of Crohn’s Disease. In: Rajesh, A., Sinha, R. (eds) Crohn's Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-01913-0_11

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