Although it’s the most invasive of the treatments available, surgery provides a viable option when other medical treatments prove ineffective. Surgery may involve repair work to the intestines, or even the complete removal of the colon. Some of the common surgical treatments are discussed here.
Bowel resection surgery involves removing a portion of the affected intestine, and then reattaching the healthy intestine on either side of the removed area. A bowel resection can offer significant pain relief, but very often the relief is temporary. In many cases, Crohn’s disease will recur in the healthy intestine next to the area that was removed.
In severe cases of Crohn’s disease involving the large intestine, removing the entire colon (a procedure called a colectomy) may be necessary. In a surgery called an ileostomy, the tip of the small intestine is connected to an opening in the lower abdomen called a stoma. Waste products leave the body through the stoma, where they are collected in a bag that can be emptied. If only a portion of the intestine is removed in a bowel resection, a temporary ileostomy may be used while the reattached intestine heals.
A colectomy is the partial or complete removal of the colon. Although a complete colectomy involves wearing an external bag to gather waste (through a stoma), many people with severe Crohn’s disease of the large intestine opt for a colectomy, having decided that the pain relief the surgery brings warrants the inconvenience of having to wear the external bag.
Ileoanal Reservoir Surgery
Ileoanal reservoir surgery can be performed if the rectum muscle is not removed during a colectomy. Instead of using an external bag attached to the intestines via a stoma to gather intestinal waste, a portion of the small intestine is made into a pouch. This pouch is then attached to the anus. An intact rectum muscle allows for bowel control.
Fistulas, Obstructions, and Other Repair Work
Surgery may also be indicated to repair secondary damage caused by Crohn’s disease. Scarring and inflammation can narrow the intestinal tract, leading to intestinal blockages. In some cases, surgery is required to clear the blockage, which otherwise causes intense pain and constipation. If the blockage causes a perforation in the intestinal lining, surgery can repair the tear.
Crohn’s inflammation affects all levels of the intestinal wall. Ulcers and sores caused by Crohn’s disease may sometimes penetrate completely through the wall, creating a fistula â€” an abnormal connection between two body structures. With fistulas involving the intestinal tract, intestinal contents can seep through the fistula, leading to contamination and bacterial infections in other parts of the body. Surgery is often necessary to repair and seal the fistula.
Surgery may also be used to correct intestinal bleeding, or to remove ulcers that don’t respond to medication.
Centocor, Inc. (nd). Treatment for Crohn’s disease.
National Digestive Diseases Information Clearinghouse. (2003, January). Crohn’s disease [NIH Publication No. 03-3410].
National Digestive Diseases Information Clearinghouse. (2003, April). Ileostomy, colostomy, and ileoanal reservoir surgery [NIH Publication No. 03-4641].
National Library of Medicine. (updated 2002). Small bowel resection. MedlinePlus Medical Encyclopedia.