Crohn's Disease of the Colon, Rectum, and Anus

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Key points

  • Intra-abdominal abscesses associated with colonic Crohn's Disease (CD) that are addressed before definitive surgery may be associated with fewer stomas.

  • Segmental colectomy for colonic CD is a viable option for patients with limited disease.

  • The definitive operation for the patient with colonic CD is total proctocolectomy with end ileostomy (TPC/I).

  • Fecal diversion when done to decrease colonic inflammation, perianal inflammation, and sepsis may become permanent.

CD of the large intestine is one of

Intra-Abdominal Abscess

Intra-abdominal abscesses can complicate the treatment of patients with CD and add additional steps in management. These steps can include percutaneous drainage, surgical drainage, and/or fecal diversion. Ideally, preoperative drainage of an abscess would obviate surgery in the acute setting, make future surgery technically easier for the surgeon and patient, and decrease the likelihood of the need for an ostomy.

da Luz and colleagues2 retrospectively reviewed the Cleveland Clinic, Ohio,

Operations and techniques for Crohn's Disease of the colon and rectum

Multiple different surgical operations exist for the patient with CD of the colon and rectum. Several pieces of information should be taken into consideration when deciding which operation is most ideally suited for the individual patient. The amount of colon involved with the colitis should be considered, as well as whether or not the rectum is involved. A digital examination of the anus and distal rectum should be done because perianal CD may contraindicate a sphincter-saving operation and

Perineal Wound after Proctectomy

The perineal wound that is created after proctectomy for CD does not always heal primarily, and delayed healing after proctectomy has been a common difficulty. This fact is especially true in the patient who has perineal CD.41 In some patients, this can be averted. The patient with an anorectal abscess should have this drained before definitive proctectomy. In addition, some patients with severe perianal CD with abscesses and fistulae may benefit from fecal diversion before definitive

Summary

The management of patients with CD of the colon, rectum, and anus is complex and has changed since the introduction of biological agents. Timing of surgery, the optimal treatment of perianal CD, and the use and avoidance of a stoma are several of the difficult issues in the management of these patients. Segmental colectomy has a role in the management of patients with CD and rectal sparing. Patients with perianal CD should be evaluated for proximal intestinal involvement. Patients with severe

Acknowledgments

The author would like to thank Marilyn Teolis for her assistance with researching this article.

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