- General Surgery
- Hernia Surgery
- Colorectal Surgery
- Bowel Conditions
- Anal Conditions
- Common Operations
- Upper Gastrointestinal Surgery
- Gall Bladder
- Stomach and Oesophagus
- Laparoscopic Surgery
- Enhanced Recovery Programmes
- Information Downloads
- Who Should Be Looking After Me?
- What is?
First described as a clinical entity in 1932 in the USA, Crohn’s disease is an inflammatory disease that may affect the whole bowel from mouth to anus. The most common sites for the disease to be found are in the last part of the small bowel (terminal ileum) and in the rectum or anal canal. It is characterised by a number of different findings that may be seen endoscopically (usually at colonoscopy), at surgery and histologically (when examined under the microscope).
Any age group may be affected but it is most commonly found in young adults (aged 16-40 years). Men and women are affected equally and family history of inflammatory bowel disease and associations with some rarer medical conditions are sometimes identified.
- Abdominal Pain – Usually cramp-like in nature
- Change in bowel habit- Usually to diarrhoea
- Weight loss
- Anal pain or discharge
- Skin problems
- Joint pains
- Some, none or all of the above may be present in people with Crohn’s Disease.
Why does the disease give these symptoms?
Crohn’s Disease’s clinical appearance is characterised by a propensity for a period of inflammation often followed by scarring and stricturing (narrowing) of the bowel. Similarly diseased bowel segments may attach themselves to other parts of the gastrointestinal tract, skin or other organs (vagina or bladder commonly) and create a passage (or fistula) between the lining of each, allowing the passage of bowel contents, the development of abscesses and wounds that fail to heal.
Pharmacological treatment of Crohn’s Disease is undertaken by specialist physicians (gastroenterologists) and consists of anti-biotic, anti-inflammatory and immune-modulating drugs as well as nutritional and supportive care. Surgeons become involved usually at the request of these physicians when disease will not respond to treatment or when complications intervene. When surgery is required specialist colorectal surgeons seek to remove most or all areas of affected bowel, drain any infection and attempt to restore normal bowel anatomy and function.
More than half of patients with Crohn’s disease will have an operation for the condition at sometime in their lives. It is also recognised that around half of these patients will need a second operative intervention of some kind later in life. It is for this reason and for the fact that Crohn’s disease cannot be “cured” that unsurprisingly patients, families and medical staff may see surgery as a last resort. While this may often be the case it should be recognised that for some, significant delay to the inevitability of surgery may be costly.
This is seen in terms of the time spent unnecessarily unwell, the extent of surgery that becomes required and the time taken to recover. As ever, full and frank discussion with experts in both the medical and surgical management of the disease is mandated.
Surgeons are taught “don’t operate on Crohn’s disease unless there are complications but don’t let the complications become complicated!”
What are the reasons for operation?
- Persistence of symptoms despite medical treatment
- Bowel obstruction
- Fistula and or abscess formation
A variety of different operations are undertaken either in a laparoscopic or open fashion. The operation performed will depend on the site of disease, its severity and the other structures involved.
Commonly performed operations are:-
- Ileocaecal Resection /Right Hemicolectomy
- Small bowel resection or Stricturoplasty
- Left Colectomy /Anterior Resection
- Drainage of perianal abscess/ Insertion of Seton