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Inflammatory bowel disease - Crohn's disease
The chronic inflammation of Crohnâ ' s disease can eventually cause scarring, which leads to narrowing in certain segments of the intestine. These narrowed areas are called strictures. If strictures do not respond to medication, a surgical procedure called strictureplasty may be used to open the blockage and widen the narrow passages.
Strictureplasty is usually performed for repairing strictures in the jejunum or ileum sections of the small intestine. It involves cutting open the strictured segment and stitching the tissue crosswise. This helps remove the area obstructing the bowel and enlarges the width of the passageway, without removing any parts of the intestine.
When Crohnâ ' s disease penetrates or severely inflames the bowel or colon, patients may require surgical resection. Resection is also performed for patients who have signs of small or large bowel perforation. (Perforation is when a hole in the bowel lets waste contents flow into the abdominal cavity.)
Resection involves removing the diseased section of the bowel and then reattaching the healthy ends of the intestine in a procedure called an anastomis. Resection can be performed either through open surgery involving a wide incision through the abdomen, or through less-invasive laparoscopy.
Disease Recurrence after Resection. About half of patients experience a recurrence of active Crohnâ ' s disease within 5 years of having resection and require a second surgery. The disease usually recurs near the site of the anastomis. Medications such as aminosalicylates and immunosuppressive drugs are given to help prevent or delay recurrence.
If Crohnâ ' s disease becomes extremely severe, and other treatments do not help, the patient may to have their entire colon removed. If the rectum is also affected, it will also need to be removed.
Patients who have colectomy still retain their rectums and are able to pass stool naturally. Because proctocolectomy involves removing the rectum, the surgeon must perform another procedure, called ileostomy, after proctocolectomy to create an opening to allow waste to pass
Proctocolectomy with ileostomy involves the following:
Surgery may also be performed to treat fistulas or drain abscesses that have not been helped by medication, to control excessive bleeding, and to remove intestinal obstructions.
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