In fact, between 70% and 90% of Crohn’s patients will require surgery in their lifetime,1 with as many as 39% of patients requiring repeated surgery.2 Some patients choose elective surgery, while in other cases the condition has become so dire that surgical intervention is necessary.
Let’s take a look at the most common conditions that Crohn’s can cause:
- An intestinal obstruction or blockage is caused by scar tissue that develops over time in the intestines as a result of long-term inflammation. This scar tissue can thicken to the point where the intestine is narrowed. The surgeon may find that the section of the intestine is too badly damaged and will need to remove it. In this case, a temporary colostomy or ileostomy will be created in order for the patient to heal. Once healing has occurred, the ends of the intestine can be reattached.
- Bowel perforation occurs when the wall of the intestine becomes weakened due to inflammation, causing a hole to develop. This can also occur due to a blockage. Surgery is required to repair the hole. If the affected portion of the bowel is too damaged to be fixed, it may be removed. A colostomy or ileostomy may be necessary.
- Fistulas are sores that can develop over the entire length of the intestines. These sores can extend through the entire thickness of the bowel wall and form a tunnel “connection” into another part of the intestine, into another organ, or even up to the surface of the skin. Fistulas can also form around the anus and cause drainage of stool or mucus. If fistulas do not respond well to medication, a fistulotomy may be performed.
- An abscess is a collection of pus which can develop in the abdomen, pelvis or anus. The presence of an abscess can cause pain, discharge and fever. Surgery is required in order to drain the abscess and allow for healing.
- Toxic megacolon is an inflammation of the colon that causes it to expand and distend, making it impossible to have a bowel movement. Eventually the colon ruptures under the strain. Emergency surgery is required, which will most likely involve removing the diseased portion of the colon.
Other types of surgery for Crohn’s disease depend upon the location of the disease (as it can affect any part of GI tract). In many cases, these surgeries are elective and chosen as a way to improve quality and prevent future problems.
Small bowel disease can lead to the following surgeries:
- Strictureplasty is performed when intestinal walls become narrowed due to scar tissue. This narrowing is referred to as a stricture and can be widened via surgery without requiring any portions of intestine to be removed.
- Small bowel resection is performed as described above, where the affected part of the bowel is removed and the ends are then reattached.
If Crohn’s disease affects the colon and/or rectum, the following large bowel resection surgeries may apply:
- Colectomy involves the removal of the entire colon and eventual reattachment of the small intestine to the anus.
- Protocolectomy involves removal of both the colon and rectum, if the rectum is also affected by the disease. In this case a permanent ileostomy is created.
If you’re battling Crohn’s disease, talk to your doctor about the many surgical options available. Many elective surgeries are minimally invasive, allowing for faster healing time and less pain.
2Chardavoyne R, Flint GW, Pollack S, Wise L. Factors affecting recurrence following resection for Crohn’s disease. Dis Colon Rectum. 1986;29(8):495-502.