Crohn’s Disease (surgical Cases)

Overview
Surgery becomes necessary in Crohn’s disease when complications like strictures, fistulas, abscesses, or perforations resist medical therapy. About 33% of patients require it within 5 years, rising to 50% over 20 years, often in the terminal ileum or colon. Procedures aim to preserve bowel length while alleviating blockages or infections, though disease recurs in 25-50% of cases.

Surgical Indications

  • Strictures and Obstruction: Fibrotic narrowing causes bloating, pain, vomiting; 25% of surgeries target this.
  • Fistulas and Abscesses: Abnormal connections or pus collections demand drainage or resection.
  • Emergencies: Bleeding, perforation, or peritonitis require urgent colectomy or diversion.
  • Growth failure in children or steroid dependency also prompts intervention.?

Procedures and Complications

Common options include ileocecectomy, strictureplasty, or segmental resection; laparoscopic approaches minimize risks. Post-op issues like leaks (anastomotic failure), infections, sepsis, or recurrence affect 13-26%, often needing reoperation. Wound healing delays occur in proctectomies.

Outcomes
Multidisciplinary care optimizes timing; biologics post-surgery cut recurrence. Quality of life improves, but lifelong monitoring prevents further crises.