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Crohn's Disease Surgery

Aug 03, 2016

Crohn’s disease is an inflammatory and chronic disease that usually affects the ileum, the lower part of the small intestine. But it also can occur in any part of the large or small intestine, esophagus, stomach or even the mouth. It can affect people at any age, though usually between the ages of 15 and 30. Medical treatment is the first-line treatment for Crohn’s disease. However, in certain cases, surgical treatment is necessary. In fact, about 75% of the patients suffering from Crohn’s disease will require a surgical treatment at some point of their life. Learn when surgery is necessary in the treatment of Crohn’s disease.

When Do You Need to Have Crohn’s Disease Surgery?

Below are some of the situations when a surgery is necessary:

1.   Intestinal Obstruction

Chronic inflammation of the intestines can cause scarring of the tissue. These scars tend to narrow the intestinal lumen, which often leads to intestinal obstruction. Nausea, vomiting, and constipation are signs of intestinal obstruction.

2.   Excessive Intestinal Bleeding

It is a very rare Crohn’s disease complication. Excessive intestinal bleeding requires surgical treatment in cases when the bleeding can’t be controlled with other methods.

3.   Bowel Perforation

The chronic inflammation of the intestines due to Crohn’s disease tends to weaken the intestinal walls, often leading to bowel perforations. Sometimes, the bowel near the obstructed intestine expands, causing the wall to weaken and bowel perforation to occur.

4.   Fistula

Ulcers are common in Crohn’s disease. When these ulcers extend through the entire thickness of the bowel wall, they tend to form a tunnel and create a fistula with another part of the intestine, or nearby organs such as the bladder, vagina or even to the surface of the skin.

5.   Abscess

A collection of the pus can develop in any part of the gastrointestinal tract. Severe abdominal pain, fever, a discharge of pus from the anus, red, tender and swollen anus, as well as painful bowel movements are characteristic symptoms. A surgery is necessary to drain the pus out for faster healing.

6.   Toxic Megacolon

Toxic megacolon is a serious complication of Crohn’s disease due to a severe inflammation of the bowels. It requires an immediate surgical treatment.

What Are the Types of Crohn’s Disease Surgery?

Here are different types of surgery for your choice.

1.   Strictureplasty

Strictureplasty is a surgical treatment necessary in cases of strictures (intestinal obstruction) resulting from Crohn’s disease. This surgery doesn't remove the strictures; it just enlarges them. More than one stricture can be enlarged during one surgery, as more than one stricture often occurs in more than one area of the small intestine. 

2.   Resection

Resection is a type of surgical treatment which includes removing a short segment of the small intestine and joining the two sides of the intestine with an anastomosis. It is usually used to treat strictures and bowel perforation. After resection surgery, the symptoms of Crohn’s disease may disappear for years. However, most of the patients will have a recurrence within the first 5 years after the surgery. Repeated resection surgeries are often necessary as the disease progresses and its symptoms reappear from time to time. Complications related to this surgery include abdominal pain, abdominal cramping, diarrhea, bleeding or even infections following the surgery.

3.   Proctocolectomy and Colectomy

Proctocolectomy is a surgical procedure during which the entire colon and rectum are removed. Colectomy, on the other hand, is a surgical procedure which involves removing the entire colon. These two types of surgical procedures are necessary only in severe cases of Crohn’s disease. Proctocolectomy often leads to an ileostomy as the rectum is removed. In cases of colectomy, chronic diarrhea often occurs.

Which One to Choose

The goal of the surgical treatment is to cure Crohn’s disease, improve the quality of life and lower the risks of gastrointestinal cancer. Your doctor will need to carefully analyze your health conditions and the merits of the surgeries. He/she will choose what is the best for you.

What Are the Possible Complications of Crohn’s Disease Surgery?

You need to closely watch for the following possible complications after surgery.

1.   Infection

Every surgical treatment has a possible risk of getting complicated with an infection, even after a few days or weeks if not cared properly.

2.   Malabsorption

Sometimes, a great portion of the small intestines is removed in surgery. As the small intestines are responsible for digestion of the nutrients, the body will not be able to absorb all the necessary nutrients, eventually causing malabsorption. Malabsorption increases the risk of nutritional deficiencies.

3.   Marginal Ulcers

Marginal ulcers are ulcers located at the site where the intestines are sewed back together, making the healing process lasting longer. Marginal ulcers can lead to infections or even bowel perforation.

4.   Pouchitis

Pouchitis is a condition when the J-shaped pouch created by the surgeon to collect the waste and slow down the transit of the waste becomes inflamed. Characteristic symptoms of pouchitis include high fever, a loss of bowel control and even blood in the stool.

When to See a Doctor

Make sure to seek professional medical help in cases when you have the following symptoms:

  • High fever
  • Abdominal swelling
  • Blood in the stool
  • Confusion
  • Chest pain
  • Shortness of breath
  • Pain that is getting worse, etc.

Diet Tips After Crohn’s Disease Surgery

Postoperative care is very important after surgery. Pain medications are often administered in order to relieve the pain, while antibiotics are necessary in order to prevent possible complications. Regular physical therapy combined with a healthy diet and a change in the lifestyle will help you recover faster.

Always depending on the type of the surgery, you will need to adjust the diet. In general, a well-balanced diet is very important which should contain all the necessary nutrients. After ostomy surgical procedures, a low-fiber diet is often recommended for the first 6 to 8 weeks. Because gastrointestinal surgeries usually impact the ability of the body to absorb the necessary nutrients, nutritional supplements are often recommended after the surgery.

Some great tips following the proctocolectomy surgery include:

  • Don’t skip meals and try to eat regularly.
  • Eat small and frequent meals instead of large meals.
  • Try to eat potatoes, rice, or pasta once daily.
  • Limit foods rich in sugar as they will just make your diarrhea worse.
  • Certain types of food should be avoided, like dried fruits, coconut, raw vegetables and fruits, spicy foods, etc.
  • Don’t forget to drink plenty of water daily as well. 
  • Limit the amount of carbonated drink and coffee.