Two-thirds to three-quarters of individuals with Crohn's disease need surgery at some point, according to the National Digestive Diseases Information Clearinghouse. Other treatments, such as medication and nutritional supplements, may also be used in treating the disease, but surgery is necessary when symptoms are recurrent, persistent or severe. Patients require different types of surgery, depending on their own complications, the location of the disease and the severity of symptoms.
Strictureplasty
If Crohn's disease affects the small intestine, healthy parts of intestine can be present alongside diseased parts. The diseased parts may start to narrow, forming strictures, according to the Crohn's and Colitis Foundation of America. These strictures can prevent digested food from moving along in the intestine and cause blockages. A surgery called a strictureplasty widens the diseased and narrow parts of the intestine, without removing any of the organ. An incision is made where the narrowing is occurring, and the tissue is then sewn up in a way that widens the intestine and relieves blockages.
Colectomy and Proctocolectomy
According to the NDDIC, a colectomy involves the removal of the entire colon. Widespread disease in the large intestine that does not respond to other treatments or drugs can require this surgery. If the small intestine cannot be connected to the rectum, an incision is made in the abdomen and the end of the small intestine is sewn to this incision; this procedure is an ileostomy. A bag attaches to the incision so that waste can leave the body. Severe Crohn's disease affecting the rectum requires more intensive surgery called a proctocolectomy. A proctocolectomy removes the colon and the rectum; an ileostomy is made in this case as well.
Resection
Numerous strictures close to each other can cause problems, and removing the entire area can help clear blockages in individuals with Crohn's disease. Removal of part of the intestine is called a resection. After the diseased portion of the intestine is removed, a procedure called anastomosis is done, joining the two healthy parts of the intestine together.
Abscess and Fistula Removal
Almost a quarter of adults with Crohn's disease will develop an abscess or fistula, according to the CCFA. An abscess is a pus-filled mass, typically the result of an infection. A fistula is an abnormal hole somewhere in the body. In the case of Crohn's disease, there might be a fistula between parts of the intestines, or between the intestines and a hollow organ, such as the bladder. Draining the abscess with a needle under CT scanner guidance is a common treatment, but surgery may be needed to remove the abscess and part of the intestine. Medication is used as a first-line treatment for fistulas, but if no response is seen, surgery is performed.
