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Crohn’s disease is an inflammatory condition of unknown etiology that can affect any portion of the gastrointestinal tract from the mouth to the perianal area. Its transmural inflammatory nature coupled with the variability of organ distribution gives rise to a spectrum of clinical presentations, each of which must be considered separately when deciding on the right therapeutic approach.
The small bowel is the diseased bowel that is usually affected, although other parts of the intestinal tract may be affected as well as the perianal area. Eighty percent of patients have small bowel involvement, usually in the distal ileum, 50 % of patients have involvement of both the ileum and colon, in 20 % of patients the disease is limited to the colon, and one-third of patients have perianal disease .
Five to 15 % have predominant mouth or gastroduodenal involvement, while fewer patients have involvement of the esophagus and proximal small bowel
The transmural nature of the inflammatory process results in fibrotic strictures. These strictures often lead to repeated episodes of small bowel, or less commonly colonic, obstruction. The typical course in patients with Crohn’s disease involving the small and/or large intestine is one or intermittent exacerbation of symptoms followed by periods of remission.
Approximately 10 to 20 percent of patients experience prolonged remission after the initial presentation.
The evolution of the surgical treatment of Crohn's disease has three attainable aims: to be minimal, safe and therefore timely. Patients with Crohn's disease are managed non-surgically until complications of the disease or failure to thrive or significant side effects of medication occur, and then at this point surgery usually is performed. Once a complication has developed, it is not recommended to wait for it to become further complicated. Resectional surgery and strictureplasty for Crohn's disease of the small bowel are currently the methods of choice. Laparoscopic intestinal surgery is very important. Abdominal surgery for Crohn's disease is not curative and is only part of lifetime patient management.
Small bowel strictureplasty is an alternative to bowel resection for Crohn’s disease patients with strictures of the small bowel, especially those who have lost a significant length of small bowel to previous resections. Strictureplasty should not be performed in an acutely inflamed bowel or if there is an associated fistula. Strictureplasty has been shown to effectively relieve bowel obstruction and ameliorate symptoms . The risks of recurrent stricture or fistula formation after strictureplasty are low and comparable to those after a bowel resection.
