Crohn’s disease is a gastrointestinal disorder usually involving the final segment of the small intestine, called the ileum. The disease may also affect the colon and rectum. Anal conditions also occur as part of Crohn’s disease and some patients may present through complex anal abscesses, fistulas or fissures.
The cause of Crohn’s disease is unknown but there is probably genetic and environmental factors at play. Patients may present with abdominal pain, diarrhoea or constipation, loss of weight or through perforation of the gut and abscess formation within the abdomen.
The diagnosis is usually made by gastroenterologists or surgeons when colonoscopies are performed allowing inspection of the lining of the colon and the final segment of small bowel. Biopsies are taken and these must reveal microscopic evidence of chronic “granulomatous” inflammation. Radiological scans are frequently used to check the whole gastrointestinal tract. Crohn’s disease frequently causes “skip” lesions where discrete and separate segments of bowel are thickened, inflamed and narrowed. These narrowed segments can cause blockage to the bowel.
Treatment of Crohn’s disease is initially with medications. Steroids, antibiotics and immune suppressing drugs are given to dampen down the inflammation and to prevent segments of bowel from being blocked. If medical therapy fails to control the inflammation of Crohn’s disease then surgery is required.
The aim of surgery is improve the symptoms of Crohn’s disease rather than to cure the disease. That is, surgery is designed to relieve bowel obstruction or resect perforated segments of bowel. Bowel is resected to remove the narrowed segments of bowel and to achieve a sort of remission where medications are then offered to prevent recurrent disease. Alternately, surgery can allow for narrowed segments to be dilated through procedures called stricturoplasty. The overall aim of surgery in Crohn’s disease is to allow successful medical management of inflammation and to maintain as much bowel length as possible.