Surgical management of crohn's disease and ulcerative colitis

Abstract

Crohn's disease (CD) and Chronic ulcerative colitis (CUC) represent the two ends of the spectrum of inflammatory bowel diseases (IBD). For both diseases, the etiology is unknown [1]. Recent research indicates that there are genetic components to both. However, genetics alone does not explain their occurrence. Many believe there is a complex interaction between genetics, environmental, dietary, and possibly infectious agents that contribute to the onset and progression of CD and CUC. While both are inflammatory conditions of the intestine, the location, extent, and histologic characteristics of the inflammation define each as distinct disease entities. There are significant differences in the pattern of intestinal inflammation between CD and CUC that lead to different manifestations of the disease. CD is characterized by transmural inflammation that may occur anywhere along the intestine from mouth to anus. Transmural inflammation leads to a number of complications unique to CD including perforation, abscess, fistula, and stricture. Surgery is not curative in CD; therefore, operations are performed for complications of the disease or to alleviate symptoms. Unlike CD, CUC is an inflammatory disease limited to the mucosa of the colon and rectum. Since the small bowel is not involved in CUC, removal of the colon and rectum cures the intestinal manifestation of the disease. In this chapter, we discuss the indications for and some technical aspects of surgery for CD and CUC.