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Review
. 2016 Oct 28;22(40):8892-8904.
doi: 10.3748/wjg.v22.i40.8892.

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

James Wt Toh  1 , Peter Stewart  1 , Matthew Jfx Rickard  1 , Rupert Leong  1 , Nelson Wang  1 , Christopher J Young  1
Affiliations
Review

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

James Wt Toh et al. World J Gastroenterol. .

Abstract

Despite advancements in medical therapy of Crohn's disease (CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD (and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.

Keywords: Colon cancer; Crohn’s disease; Inflammatory bowel disease; Major abdominal surgery; Perianal; Surgery.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare (refer to signed statement by the corresponding author).

Figures

Figure 1
Figure 1
Indications for surgery in Crohn’s disease. DALM: Dysplasia-associated lesion or mass.
Figure 2
Figure 2
Stricturing disease. SLB: Strictured large bowel; SI: Strictured ileum.
Figure 3
Figure 3
Large bowel stricture in Crohn’s disease. Final pathology adenocarcinoma (arrow).
Figure 4
Figure 4
Pseudopolyps (arrow marks a pseudopolyp) in Crohn’s disease.
Figure 5
Figure 5
Ileosigmoid fistula with arrow marking contrast. Contrast flowing from ileum to sigmoid. I: Ileum; S: Sigmoid.
See this image and copyright information in PMC

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