About three-fourths of Crohn’s patients will need Crohn's surgery, often more than once. When faced with such high odds it’s important to understand your risks, and make sure you have the best surgeon possible.
According to Scott Strong, MD, a colorectal surgeon with the Cleveland Clinic, Crohn's surgery might be necessary when you don't respond to medications and when there are complications.
When You Don't Respond to Medications
The most common reason for surgery is because medications are not effective in controlling inflammation. Dr. Strong said that about a third of people with intestinal inflammation will experience a manifestation of the disease in other parts of the body, such as the calves, joints, liver, skin, and eyes. If medications don’t work, a section of the intestine may have to be removed. “Hopefully, the other areas will quiet down,” he said.
Inflammation that goes untreated also can increase the likelihood of cancer or cause pre-cancerous changes in the bowel. Removal of that portion of the bowel may be necessary to stave off future problems, he added.
In the small bowel, a relatively common operation called a strictureplasty typically is done when the intestine narrows. Rather than remove a section of bowel, which can compromise your body’s ability to absorb nutrients, this operation involves a cross-wise cut that ultimately causes the bowel to balloon, and often the inflammation to resolve itself.
Less common reasons for Crohn's surgery include complications that don't respond to medication:
Severe bleeding. This unusual condition happens when the lining of the bowel deteriorates, exposing the submucosa. The affected section is then removed.
Perforation. Occasionally a hole forms in the bowel at the site of an inflammation. If the hole connects one section of bowel with another or with the bladder, it is called a fistula and is not an emergency. But if the contents spill into the abdominal cavity, the situation can be life-threatening.
Abscess. If your body tries to “wall off” the perforation, it can create an abscess. If the abscess can't be drained and infection sets in, you may need surgery to correct it.
Severe colitis. When the large intestine becomes inflamed, sometimes the best option requires removal of the entire colon.
Finding the Right Surgeon
Your priority is to find a colorectal surgeon experienced in Crohn's surgery in particular. Strong explained that even though X-rays and other studies are done when preparing for surgery, “it’s not uncommon to find something different, or in addition to what you knew going in, and you have to be able to respond and change the operation based on what you’re finding. That is why you’re better off with someone with experience or who is well-versed in the surgical management of Crohn’s.”
While you may not find a surgeon who specializes only in Crohn’s, Strong says the surgeon you choose should have experience with more than just a few cases and be able to discuss the disease.
He or she also should be board certified in either general surgery or colorectal surgery and ideally a member of the Crohn’s & Colitis Foundation of America. “That tells you where their interest lies,” he added.
Your primary care physician or gastroenterologist should be able to refer you to skilled surgeons. Other options include searching the Crohn’s & Colitis Foundation Web site. The American Society of Colon and Rectal Surgeons also offers help in locating a surgeon.
Teamwork for Crohn's Surgery Success
Once your medical team is in place, it’s important that they all work together and communicate.
Strong's office is next door to a gastroenterologist — “That’s ideal,” he said. Important records also can be shared by e-mail, and phone and video conferences are helpful for discussing your condition and coordinating your care.
Be sure to include a family member or close friend on your team, and bring him or her on visits with your surgeon. Your loved one can serve as an extra pair of eyes and ears while offering moral support and helping convey your symptoms, recovery, and other concerns.
Last Updated: 5/23/2014