When is Surgery an Option for Crohn's Disease
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Surgery for Crohn’s Disease

What is Crohn’s disease?

Crohn’s disease is an inflammatory bowel disease that causes chronic inflammation of the intestinal tract. The inflammation usually affects the end of the small intestine, or ileum, and the first portion of the colon. However, the disease may develop in any part of the intestinal tract, including the:

  • mouth
  • esophagus
  • stomach
  • rectum

Crohn’s disease can also occur in the layers of the intestinal lining. The persistent inflammation and irritation often cause uncomfortable symptoms, such as:

  • diarrhea
  • bloating
  • abdominal pain
  • fatigue
  • a loss of appetite
  • nausea
  • bloody stool

Most people with Crohn’s disease need treatment. While there’s no cure for the disease, doctors can prescribe medications intended to control inflammation and ease symptoms.

When is surgery indicated for Crohn’s disease?

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Medication isn’t always enough, and some people with Crohn’s disease eventually need surgery. An estimated 75 percent of people with the disease require some type of surgery to relieve their symptoms. Surgery is often considered a last-resort treatment for Crohn’s disease.

If your doctor finds cancerous tissue or potentially cancerous indicators in the colon, you may need surgery. People with Crohn’s disease are at an increased risk for colorectal cancer, but removing certain sections of the colon may help prevent this type of cancer from developing.

You may also need surgery because the medications you’re taking cause severe side effects or they’ve stopped working as effectively.

If Crohn’s disease is creating complications that are a medical emergency, you may also need surgery. These complications can include:

  • a bowel abscess
  • a bowel perforation
  • a fistula, which is an abnormal connection between two cavities, such as the rectum and the bladder
  • an intestinal blockage or obstruction
  • toxic megacolon
  • uncontrolled bleeding

Though surgery can help many people living with Crohn’s disease, all operations involve certain risks. Some types of surgery may not be appropriate for you. You and your doctor can evaluate your risks for surgery and discuss whether surgery could help you live a healthier life.

Types of surgery for Crohn’s disease

 Type 1

The type of surgery your surgeon will perform depends on the part of the intestinal tract that’s affected.

Ostomy

Am ostomy involves creating a hole for your body to eliminate its contents. Your surgeon may perform this surgery after you’ve had a portion of the small or large bowel removed. When your surgeon performs this procedure on your small bowel, it’s called an ileostomy. When they perform this procedure on your large bowel, it’s called a colostomy. A colostomy and an ileostomy involve creating a hole in your abdomen. In some cases, the surgeon can reverse this procedure once the bowel has had time to heal.

Examples of other surgeries used to treat Crohn’s disease include the following:

  • a bowel resection, which involves removing the damaged portion of the intestine
  • a colectomy, which involves removing diseased sections of the colon
  • a proctocolectomy, which consists of removing the colon and rectum and often involves creating an ostomy to collect waste products
  • a strictureplasty, which involves shortening and widening the intestines to reduce the effects of scarring.

Surgeons can perform most of these procedures using a minimally invasive technique, or laparoscopy. These methods involve making small incisions and using special instruments and cameras to view the inside of your body. In some cases, however, the surgeon may need to make larger incisions during procedures.

Risks of surgery for Crohn’s disease

Risk Factors

All surgical procedures carry certain risks. If you’re having surgery for Crohn’s disease, it’s possible for your surgeon to cut an area of healthy bowel accidentally, which could result in significant bleeding. Additional risks include the following:

Infection

Any surgery that involves incisions carries risks for infection. Opening the body cavity makes it possible for harmful bacteria to enter and infect the body. Surgical incisions may also become infected after surgery if they aren’t cared for properly.

Malabsorption

The small intestine is responsible for digesting a lot of the nutrients in your food. Surgery to remove all or a portion of your small intestine can cause malabsorption. This condition affects your body’s ability to absorb enough nutrients, which increases your risk for nutritional deficiencies.

Marginal ulcers

Marginal ulcers may develop at the site where your surgeon sews the intestine back together. This prevents the area from healing properly. The result can be very painful and lead to infection or bowel perforation.

Pouchitis

Pouchitis can occur after your surgeon removes the colon if they reconnected the end of your small bowel to your anus. This procedure is called an ileoanal anastamosis. During this procedure, your surgeon creates a J-shaped pouch to collect waste and slow the transit of that waste to the anus. This reduces incontinence. Pouchitis occurs if this J-shaped pouch becomes inflamed. Common symptoms of pouchitis include a loss of bowel control, blood in the stool, and a fever.

Strictures

Strictures, or scarring, might develop at the surgery site. The resulting damage may make it difficult for digested food and stool to pass through your body. This can eventually lead to a small bowel obstruction or bowel perforation.

There’s also a chance that some surgeries won’t work as intended and the symptoms may continue.

It’s important that you and your doctor discuss these risks before surgery. Typically, surgery isn’t recommended if the risks outweigh the benefits.

Minimizing your risks for post-procedure complications involves listening carefully to your doctor’s instructions after surgery. This includes keeping your incisions clean and dry and following any special diet your doctor may recommend.

When to call your doctor

when to see a doctor

You should call your doctor if you develop any serious symptoms that could indicate the presence of an infection or another complication. These symptoms include:

  • abdominal swelling
  • blood in the stool
  • chest pain
  • confusion
  • a fever above 101°F
  • pain that doesn’t subside over time
  • pus or foul-smelling discharge coming from the incisions
  • shortness of breath
  • an inability to eat or drink anything

Call your doctor immediately if you experience any of these symptoms after surgery.

Recovering from surgery for Crohn’s disease

Treatment

The length of recovery time can vary depending on the surgical approach and the type of surgery performed. Some people may only need to stay in the hospital for a few days after surgery. Others may have to stay for a couple of weeks. Talk to your doctor about the estimated recovery time for your particular surgery.

Your doctor will give you instructions for how to recover at home. Many people are encouraged to eat a low-fiber, low-residue diet following surgery. This gives your bowel time to rest because it doesn’t have to work as hard to digest foods.

Examples of low-fiber, low-residue foods include:

  • avocado
  • canned or cooked fruits
  • pasta
  • potatoes
  • rice
  • well-cooked vegetables

You may occasionally feel tired or uncomfortable during recovery. However, you should feel much better as your recovery period comes to an end. Ideally, your surgery should reduce your Crohn’s disease symptoms.

Finding support after surgery for Crohn’s disease

While surgery can certainly help ease symptoms, the removal of part of your intestine can change your life. It may affect the way you eat, drink, and use the bathroom. If you’re having trouble adjusting after surgery, you should consider joining a support group.

Many support groups are available. You can join them to discuss your challenges with others who’ve had or who are going through similar experiences. To find support groups in your area or online, visit the Crohn’s & Colitis Foundation of America and United Ostomy Associations of America websites. You can also ask your doctor if they can recommend any local support resources. 

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