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INFLAMMATORY BOWEL DISEASE - PART 6

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180 Hurst CROHN’S DISEASE The clinical presentations and complications of Crohn’s disease (CD) vary greatly and thus a wide range the surgical techniques are employed for the operative management of this disease (Table 3). CD is a recurring disorder that cannot be cured by simple surgical resection. Surgery, thus, is intended to provide palliation. When appropriately applied surgical therapy often provides significant and prolonged relief of debilitating symptoms and can resolve potentially life-threatening complications associated with CD. In each case, the surgeon must strive to alleviate symptoms as effectively as possible without exposing the patient to excessive morbidity. Optimal surgical management is accomplished. | 180 Hurst CROHN S DISEASE The clinical presentations and complications of Crohn s disease CD vary greatly and thus a wide range the surgical techniques are employed for the operative management of this disease Table 3 . CD is a recurring disorder that cannot be cured by simple surgical resection. Surgery thus is intended to provide palliation. When appropriately applied surgical therapy often provides significant and prolonged relief of debilitating symptoms and can resolve potentially life-threatening complications associated with CD. In each case the surgeon must strive to alleviate symptoms as effectively as possible without exposing the patient to excessive morbidity. Optimal surgical management is accomplished only when the surgeon is mindful of the natural history of disease and the high risk for recurrence. This may require nonresectional techniques such as strictureplasty to avoid excessive loss of intestine or may even require surgical treatment of only portions of the gastrointestinal tract affected by severe disease while leaving segments with mild asymptomatic disease intact. Indications for Operation Failure of medical management to adequately control symptoms and disease activity is the most common indication for surgery 2 Table 4 . Medical treatment fails when symptoms of an acute flare do not improve or new complications of CD develop on optimal treatment. Some patients fail medical therapy because they develop significant side effects related to the medical therapy others may experience resolution of symptoms with systemic steroid therapy only to recur with each attempt to wean the steroids. Because severe complications are inevitable with prolonged steroid use surgery is indicated if the patient cannot be weaned off corticosteroids within 3-6 mo. Partial or complete intestinal obstruction is a common indication for surgery for CD 42 . Chronic partial small bowel obstruction is much more common than acute complete obstruction. Luminal narrowing and