Surgery is treatment option that can be used in a variety of ways to help people with Crohn's disease.
It is also an option that most Crohn's sufferers will have to deal with at some point.
As many as three out of four people with Crohn's will have some sort of surgery to help them deal with the disease, according to the Mayo Clinic. A lot of these people will have to have surgery more than once.
Crohn's disease sometimes causes ulcers within the intestines. If these are severe enough, they can create tunnels in the intestines called fistulas. Abscesses—pockets of infected material—can also form.
These can be very serious, even life-threatening conditions, and surgery can be used to repair the tunnels or treat the abscesses.
Surgical procedures can also be used to remove scar tissue in diseased portions of the digestive tract or to widen portions that inflammation has narrowed.
In other cases, the main treatments for Crohn's – medication and lifestyle changes – are not proving effective in relieving the symptoms. Surgery then may be the only option for keeping the disease in check.
In those cases, diseased portions of the gastrointestinal system are removed, and the affected area is rearranged to allow digestion of food and removal of waste from the body to continue.
The scale of this surgery can range from removing smaller portions of the small or large intestines, to the complete removal of the large intestine and rectum. When possible, the healthy portions of the affected areas are reconnected once the diseased portions are removed.
Unfortunately, surgery does not cure Crohn's disease and it also is not always effective in preventing flare-ups of the disease. It can recur in other portions of the gastrointestinal system, or even in the areas immediately around where the surgery took place.
The American Gastroenterological Association lists these situations as warning signs that surgery may be needed for Crohn's disease and other inflammatory bowel diseases:
- the patient is suffering from significant bleeding
- the disease is causing long-term, serious illness
- ulcers have formed fistulas in the intestines
- medication and other treatment options are not working
- the disease has caused a blockage
- the patient has been diagnosed with cancer
Michael Zadeh, a doctor in Encino, Calif., said surgery for Crohn’s disease is usually reserved as a last resort for those patients who have not found success with medical therapy or find themselves under emergency situations. The location of where a surgery is performed depends on the area of the intestine affected and the severity of the disease.
A strictureplasty can be used to treat areas of narrowing (“strictures”) which create intestinal blockages, Dr. Zadeh said. The narrowed area is widened, but none of the small intestine is taken out. However, it can only be used for short segments of narrowing – less than 6 inches.
“For strictures that are very long or for areas that contain many strictures close to each other, a resection of that portion of the intestine can be performed,” he said. “In a resection, the affected part of the intestine is cut out and removed and the two healthy ends are reconnected.”
Emergency situations that could require surgery would include intestinal rupture, obstruction, bleeding or overwhelming infection, Dr. Zadeh explained.
“In rare circumstances the disease is so severe or an overwhelming infection develops that surgery may be needed to remove the entire colon (colectomy),” Dr. Zadeh said. “Sometimes the rectum may need to be removed along with the colon.
“This procedure is called a proctocolectomy, and when performed, it must be accompanied by an ileostomy which involves bringing the end of the remaining small intestine (ileum) through a hole (stoma) created in the abdominal wall,” he said. “This allows the intestinal waste to drain outside of the body into an external bag which is emptied several times a day.”