Surgical Management of Crohn's Disease

Patient Guideline Summary

Publication Date: July 1, 2020

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the American Society of Colon and Rectal Surgeons (ASCRS) for surgical management of Crohn's disease. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract (GIT) not caused by infection.

We will use the abbreviation CD throughout this summary to refer to Crohn’s disease.

There are no known causes or cures for Crohn’s disease.

Medical treatment of symptoms is the first choice, but surgery is often required when that fails.

Symptoms include diarrhea, abdominal pain, weight loss, and fever.

Colon cancer risk is increased. Crohn’s disease can cause other conditions like anemia, arthritis, and osteoporosis.

This patient summary focuses on the surgical management of Crohn’s disease.

Treatment

Multidisciplinary care with gastroenterologists, surgeons, radiologists, pathologists, and other ancillary team members is critical for optimizing patient care.

Surgery is appropriate:
- When medical treatment is not helpful
- For bowel obstruction or perforation
- For fistulas (abnormal channels between the bowel and other organs)
- For cancer
Before surgery:
- All medications should be reviewed.
- Nutrition should be optimized.
- Smoking should stop.
Endoscopic (minimally invasive) surgery may suffice for uncomplicated problems like short-segment strictures (narrow segments due to scarring).

Surgical procedures may include:
- Removal of segments of the bowel
- Rerouting bowel to bypass diseased passageways
- Enterostomy (diversion of the bowel through the skin, requiring a bag to collect excrement)
- Closure of fistulas
- Stopping bleeding
- Biopsy of suspected cancer
After surgery, continued medical treatment should be considered.
Long-standing Crohn’s disease of the colon requires periodic endoscopic screening for cancer.

Abbreviations

ASCRS: American Society Of Colon And Rectal Surgeons
CD: Crohn's Disease
GIT: Gastrointestinal Tract

Source Citation

Lightner AL, Vogel JD, Carmichael JC, Keller DS, Shah SA, Mahadevan U, Kane SV, Paquette IM, Steele SR, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Crohn's Disease. Dis Colon Rectum. 2020 Aug;63(8):1028-1052. doi: 10.1097/DCR.0000000000001716. PMID: 32692069.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.