Crohn’s disease is a chronic condition of the bowel that can lead to narrowing of the bowel (strictures) or abnormal connections between different bits of bowel or bowel and other organs (fistulas). It can affect any part of the intestine, but most commonly affects the last part of the small bowel (terminal ileum).
The management of Crohn’s disease requires careful assessment and liaison between gastroenterologists, colorectal surgeons and radiologists to ensure that patients are offered the most appropriate treatment for how their condition is at a given time. I have regular multi-disciplinary meetings (MDT’s) with our gastroenterologists and radiologists where patients having a more difficult time are discussed. This is in keeping with the nationally set out IBD Standards.
Your gastroenterologist will be able to discuss the medical management of Crohn’s disease with you, and advise you on the different treatments that are available. It is extremely important to stop smoking after being diagnosed with Crohn’s disease. There is a large amount of evidence to show that smokers suffer more complications of the disease and are at significantly increased risk of disease recurrence following surgical treatment.
When it is felt that surgical intervention is required, your gastroenterologist will explain the need to refer you to a surgeon. This should not be seen as a failure of medical therapy, but as another step in path of managing your condition. The role of surgery is to try and deal with any strictures or fistulas that are causing problems, whilst preserving as much healthy bowel as possible. For short strictures it is possible to surgically widen these without the need to remove any bowel. This is called a strictureplasty. However, longer strictures will usually require a bowel resection. It is normally possible to join the ends of any resected bowel together, avoiding a stoma, although sometimes this may become necessary. You will be advised how likely this is when you are seen in the surgical clinic. If it is felt that a stoma may be necessary, an appointment will be arranged for you to meet our Stoma Nurse Specialists closer to your operation.
When there are fistulas around the anus, the aim of surgery is to try and drain any associated abscesses and decrease the likelihood of further formation, whilst preserving the integrity of the anal muscles to prevent problems with continence. It is common to have a thread of suture material or rubber passed through the tract (a seton). Medical treatment with biological therapy (e.g. Infliximab) may be used as an adjunct.
Crohn’s and Colitis UK. Link
Ileostomy Association. Link
IBD Standards. Link