Crohn’s disease

Abstract

Crohn’s disease can affect any part of the GI tract, but three common patterns of disease that come to the attention of the surgeon are ileal, colonic, and perianal disease. The terminal ileum is the most common site of severe disease, where it can cause strictures, fistulae, or abscesses. Ileocecectomy is the most common surgical procedure in patients with Crohn’s disease and is well suited to a laparoscopic approach. Most operations can be performed on a semi-elective basis rather than as an emergency. Ileostomy is rarely indicated after ileocecectomy and only under extreme circumstances. Patients with severe Crohn’s colitis are candidates for temporary ileal diversion, partial colectomy, or subtotal colectomy. Colectomy can usually be performed laparoscopically. It is sometimes difficult to distinguish fulminant ulcerative colitis and severe Crohn’s colitis, especially in young children. Manifestations of perianal Crohn’s disease can be understood principally in three categories: (1) fissures and skin tags, (2) fistulas and abscesses, and (3) rectal stricture. Fistulae are rarely cured with surgery but are best controlled with temporary drains and non-cutting silk setons. Most strictures respond to periodic anal dilatation but in severe cases are an indication for colostomy.