When is Surgery an Option for Crohn's Disease?

July 27,2021 |
Woman talking to her doctor

Crohn’s disease is a type of inflammatory bowel disease where chronic inflammation attacks the intestinal tract. It may develop and present itself in any part of the intestinal tract but is most commonly localized at the end of the small intestine (ileum) and beginning of the large intestine (colon). There is currently no cure for Crohn’s disease. Here, we’ll explore when surgery is an option for Crohn’s disease treatment.

Treatment Options for Crohn’s Disease

Crohn’s disease can develop in anyone, regardless of age. However, development is more common in people between the ages of 20 and 29, those who have an immediate family member with inflammatory bowel disease, and people who smoke. Some common symptoms of Crohn’s disease include diarrhea, bloating, fatigue, a loss of appetite, bloody stool, abdominal pain, and nausea. If diagnosed, your doctor will work with you to develop an individualized treatment plan.

Treatment for Crohn’s disease differs across individuals. Most often, a combination of medication, lifestyle changes, and surgery are performed. The goal of treatment is to reduce the overall levels of inflammation across your intestines, thus alleviating symptoms and aiding in the recovery of your intestinal lining. Common medicines prescribed for Crohn’s disease include aminosalicylates, corticosteroids, immunomodulators, biologic therapies, and more. Lifestyle changes include limiting processed foods or irritants, quitting smoking, and learning more about what triggers a flare up in your body.

Unfortunately, medication isn’t always enough to effectively manage the symptoms of Crohn’s disease. In fact, about 75% of people with Crohn’s disease will need some type of surgery after their diagnosis.

When to Undergo Surgery for Crohn’s Disease

Crohn’s disease can vary in severity, but often causes several unpleasant side effects. If the disease worsens, or flares up, it can lead to complications that require surgery. While not everyone who is diagnosed with Crohn’s disease will need surgery, a high proportion of those affected undergo it at some point in their lifetime. Surgery helps improve the quality of life for those living with Crohn’s disease and in some instances, is considered a life-saving necessity.

There are a few primary goals when performing surgery for Crohn’s disease. Surgery works to help conserve as much bowel as possible, alleviate serious complications or disrupting side effects, and improve the overall quality of life for those affected. Some instances that require surgery for Crohn’s disease include:

Intestinal Obstruction or Blockage

Over time, inflammation can cause walls of the digestive tract to thicken or form scar tissue. The build-up of scar tissue and increasing thickness leads to the formation of narrow intestinal passages, also known as a stricture. If these become too narrow, they can result in partial obstruction or complete blockage.

Excessive Intestinal Bleeding

Although rare, sometimes people living with Crohn’s disease experience excessive or uncontrollable internal bleeding. It’s isolated in the intestines and requires immediate attention. If bleeding cannot be controlled, surgery is required.

Perforation of the Bowel

Bowel perforation occurs when a hole forms in the walls of the intestines. This can occur due to several reasons, most commonly from a weakened area within the digestive tract. If a perforation occurs, the contents of your digestive tract can spill into your abdomen, which results in very serious infections and can be fatal if untreated.

Fistula Presence

Fistulas are a type of ulcer that extends through the entirety of the intestinal wall. They often form a tunnel between different areas of the intestine, therefore disrupting the flow of your digestive tract. They can also extend into nearby organs, like the bladder, or even through the surface of the skin.

Abscess Formation

An abscess is the medical term for a collection of pus. It’s usually caused by an infection and often occurs in people living with Crohn’s disease. Abscess formation requires surgical drainage and antibiotics to overcome the infection and avoid spreading.

Toxic Megacolon

Toxic megacolon is a rare, life-threatening complication. Symptoms include swelling of the belly, pain, fever, rapid heart rate, shock, and diarrhea. Seek medical care immediately if you think you may be experiencing toxic megacolon.

Elective Crohn’s Surgery

If your symptoms are severe and impacting your quality of life, your doctor may recommend undergoing elective Crohn’s surgery. This is also an option for those who stop responding to medication or have excessive side effects from medication. If you’re interested in your options for elective Crohn’s disease surgery, talk to your doctor today.

Colorectal Cancer Prevention

Since Crohn’s disease increases your risk for colorectal cancer, some people decide to undergo elective surgery. This surgery removes certain areas of the colon to help reduce the likelihood of developing colorectal cancer. If precancerous cells are found, the surgery will be performed as a treatment option to stop or slow the progression of cancer.

If you’re suffering from severe Crohn’s disease symptoms, have any of the above complications, or are looking to find some answers to your questions, contact your doctor or seek medical attention immediately. While there are alternative treatment options, surgery may be the best action to reduce further damage.

Crohn’s Disease Surgical Risks

As with any surgery, surgery for Crohn’s disease comes with risks. However, in many instances, the benefits far outweigh these risks. If you’re worried, or have any questions, speak with your doctor about potential complications that are associated with Crohn’s disease surgery. The most common risks include the following:

  • Infection – all surgeries carry a risk for infection due to the exposure of internal organs to external conditions. Follow your doctor’s recovery plan to reduce you risks of problems with the surgical incision and seek medical attention immediately at the first sign of infection.

     

  • Malabsorption – if all, or a portion, of your small intestine is removed, you may have a harder time absorbing nutrients from your food. Talk with your doctor about how to compensate for any nutritional deficiencies following surgery.

     

  • Marginal Ulcers – these are a specific type of ulcers that can form at the surgical site. If they occur, it can hinder healing and lead to infection, perforation, or high levels of pain.

     

  • Pouchitis – if you receive a j-pouch, you’re at risk for developing pouchitis. This inflammation of the j-pouch can lead to loss of bowel control, blood, and high-grade fevers.

     

  • Strictures – this is another way of describing the effects of scarring, which can develop internally at the site of surgery. Strictures can lead to difficulty digesting and passing stool. If you develop strictures, you’re at a higher risk of obstruction or perforation.

     

    Different Surgical Procedures for Crohn’s Disease

    Since Crohn’s disease can cause different symptoms in different individuals, based on location and severity of the disease, there are several surgical procedures performed.

  • Ostomyan ostomy is a type of surgery that involves creating an opening in the abdominal wall (stoma) so that waste is redirected from damaged or diseased organs. For Crohn’s disease, two types of ostomies may be performed: an ileostomy or a colostomy.

     

  • Ileostomyan ileostomy is a surgery that takes the lowest part of the small intestine and attaches it to an opening on the abdominal wall so that the colon is bypassed during digestion.

     

  • Colostomy – a colostomy is when a piece of the colon is diverted and led through the abdominal wall so that waste bypasses the damaged area of colon.

     

  • Colectomy – this is a surgery performed to remove the colon. While this can be reversible, permanent colectomies are more common in Crohn’s disease.

     

  • Proctolectomy – this surgery removes the colon as well as the rectum. It permanently alters your gastrointestinal tract.

     

  • Bowel Resection – bowel resection surgery involves removing a specific portion of your small or large intestine. The area is usually one that’s been damaged by Crohn’s disease and cannot be revitalized. There are different types of bowel resection surgeries, each depending on the localization of the damage.

     

  • Strictureplasty – this is a surgical procedure that’s done to repair a stricture by widening the area. It does not involve removing a portion of the intestine.

     

  • Abscess Drainage – to initiate healing, abscesses may need to be drained. This procedure surgically drains the pus to help the area fully heal and respond to antibiotics.

     

  • Fistula Removal – this procedure removes any fistulas that have formed within the intestines. There are several different surgical options that can be performed to remove fistulas.

If you’re living with Crohn’s disease and are experiencing severe symptoms, don’t hesitate to talk to your doctor. Surgery is an option to help mitigate problems associated with Crohn’s disease and can improve your quality of life. While ostomies may result in permanent changes, they’re often considered life-saving procedures. To help cope with any challenges, consider joining an ostomy support group and finding a pouching system that works for you. Byram Healthcare has a range of supplies to help make sure you’re comfortable, confident, and covered.

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