Surgical Options For Crohn’s Disease

Crohn’s Disease is one of the diseases that fit under the umbrella called Irritable Bowel
Disease (IBD for short).Like Ulcerative Colitis, Crohn’s disease can be just as
devastating and debilitating in it’s symptoms. A major difference is that Ulcerative
Colitis affects the colon where as Crohn’s disease not only affects the colon, but it can
also affect the small intestine or the stomach. Medication may be tried at first, to
alleviate Crohn’s disease, but if the disease is not responsive to medications, then
surgery may be necessary. But even with surgery the disease can make a reappearance in a
previously unaffected portion of the intestine. The goals of surgery for Crohn’s are to
conserve as much bowel as possible, alleviating complications and achieving the best
quality of life as possible for the patient.

Several surgical options are available depending on the type of complication involved, the
location of the disease as well as the severity of the illness. These options are called
Strictureplasty, Resection, Abscess and Fistula Surgeries and Ileostomy. Complications of
the disease that might result in surgery would include perforation of the bowel, the
formation of an abscess or fistula, severe bleeding in the intestines, obstruction or
blockage of the intestines, and the dilation and loss of muscle tone in the colon, known
as Toxic Megacolon.

Strictureplasty: Strictureplasty is an option when the disease affects the small intestine
and when the diseased portion alternates with the areas of normal bowel. The diseased
section blocks the passage of digested food by forming strictures, which is done by the
narrowing of the bowel. The normal bowel pushes against the stricture in attempt to
compensate for the diseased part. This results in causing severe cramps. Strictureplasty
widens the stricture area without the removal of any section of the bowel.

Resection: A Resection involves the removal of the affected portions of the intestine and
is an option for multiple strictures that are close to one another or for longer
strictures. After the diseased section is removed, the two healthy sections of intestine
are joined together in a procedure call an anastomosis. Patients are generally symptom
free after resection surgery; however, it is known that the disease might re occur around
or at the anastomosis site.

Abscess and Fistula Surgeries: Abscesses and Fistulas are somewhat common among those with
Crohn’s disease. One in every four will be affected by them in their lifetime. An abscess
is tender mass that is filled with pus that often results from an infection. The pus is an
accumulation of fluid, living and dead white blood cells, dead tissue, and bacteria or
other foreign invaders or materials. It can be fatal if left untreated and therefore a
prompt draining of the abscess is necessary. With the help of a CT scanner, a needle is
inserted and guided to the abscess site. It is a very easy surgery which requires a very
short hospital stay or done on an outpatient basis, depending on the severity of it. For
relief of swelling, pain also helping with draining further, a warm sitz bath is very
helpful in recovery. A fistula is an abnormal connection between two organs, an organ and
another structure, vessel, or intestine. It can even form between an abscess to a hollow
organ. While some are treated with medication, others require surgery to perform a
resection of the involved bowel.

Ileostomy:For those with severe crohn’s that affect the colon, ileostomies are performed.
An ileostomy is an opening that is made at the end the small intestine, the ileum. The
ileum is brought through the abdominal wall, therefore creating what is called a stoma.
The waste is collected in a specially made bag that is attached on the outside of the
body. These bags are lightweight and are attached with an adhesive wafer that is made of
pectin or another organic material. The wafer has a cut out hole that fits around the
stoma to prevent leakage onto the skin and therefore preventing skin irritation.

It is advisable for people who face this decision to know as much about the procedures as
possible for reassurance. They can get more information through their doctors, literature
and enterostomal therapists as well as other patients. Surgeries make is possible for the
patient to live a healthy and productive life.

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