In order to understand the following procedure options, it is important to note that “bowel” can refer to either the small or large intestine, while “colon” refers specifically to the large intestine.
A very common operation for Crohn’s disease is a bowel resection. This refers to the removal of diseased segments of the small or large intestine. After the inflamed portion is removed, the surgeon reconnects the healthy ends of the intestine back together, creating an “anastomosis.” This procedure brings relief, but symptoms may return after a few years. Most often, the symptoms originate at the site where the intestine was reattached.
Although colectomies are much more common in patients with ulcerative colitis, a small percentage of patients with Crohn’s colitis may require the removal of the colon. A colectomy refers to removal of a part of the colon (partial colectomy) or the entire colon (total colectomy). In a total colectomy, the rectum is not removed. A total colectomy with ileorectal anastomosis (IRA) is when the surgeon connects the small intestine to the rectum. This allows the patient to pass stool naturally.
As with total colectomies, proctocolectomies are more common for patients with ulcerative colitis. In rare, severe cases of Crohn’s disease, however, proctocolectomies may be recommended. A proctocolectomy involves removing the entire colon and the rectum. There are versions of proctocolectomies that can preserve continence, but they have a failure rate in Crohn’s disease, and are used less often than in patients with ulcerative colitis.
An ileostomy is when the end of the small intestine (ileum) is brought through an opening in the abdominal wall after the removal of the large intestine. This leaves the patient with an opening on the surface of the belly called a stoma, which allows stool to leave the body. An inconspicuous bag is attached to the stoma that collects the stool and is emptied a few times daily.
Sometimes the colon is used to create a stoma. This is called a colostomy, not an ileostomy.
A strictureplasty is an operation to widen the intestine after scarring from repeated inflammation and healing has caused the intestine to narrow. The narrowing of the bowel can lead to bowel obstructions, and a strictureplasty can relieve this obstruction.
Perianal disease is another area that often needs surgery in Crohn’s disease. Abscesses near the anus can develop acutely and need surgical drainage. Some patients develop a fistula from the anus to the skin of the bottom which can result in chronic drainage and may need surgery. Some patients develop fissures, or tears in the lining of the anus, from the Crohn’s disease. These often do not require surgical treatment.