Skip to main content

Abstract

Surgical intervention in patients with Crohn’s disease is limited to the treatment of acute and chronic complications for which medical therapy is not effective. At the Cleveland Clinic, rates of surgery with disease of 10 years’ duration were 90% of patients with ileocolitis and 70% of those with only ileal involvement (1). Thus, for the vast majority of patients with Crohn’s disease involving the small bowel, surgery is unavoidable. The surgeon treating these patients must be familiar with the spectrum of complications that may require specific surgical interventions. Resection of the diseased small bowel, the subject of this chapter, is a very effective short-term treatment for most complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Farmer R, Hawk W, Turnbull R. Indications for surgery in Crohn’s disease. Gastroenterology 1976;71:245–250.

    PubMed  CAS  Google Scholar 

  2. Fazio V, Marchetti F, Church J, et al. Effects of resection margins of the recurrence of Crohn’s disease in the small bowel. A randomized controlled trial. Ann Surg 1996;224:563–573.

    Article  PubMed  CAS  Google Scholar 

  3. Platell C, Mackay J, Collopy B, et al. Crohn’s disease: a colon and rectal department experience. Aust N Z J Surg 1995;65:570–575.

    Article  PubMed  CAS  Google Scholar 

  4. Bergman L, Krause U. Crohn’s disease: a long-term study of the clinical course. Scand J Gastroenterology 1977;12:937–944.

    Article  CAS  Google Scholar 

  5. Nagler S, Poticha S. Intraabdominal abscess in regional enteritis. Am J Surg 1979;137:350–354.

    Article  PubMed  CAS  Google Scholar 

  6. Doemeny J, Burke D, Meranze S. Percutaneous drainage of abscesses in patients with Crohn’s disease. Gastrointest Radiol 1988;13:237–241.

    Article  PubMed  CAS  Google Scholar 

  7. Ayuk P, Williams N, Scott N, et al. Management of intra-abdominal abscesses in Crohn’s disease. Ann R Coll Surg Engl 1996;78:5–10.

    PubMed  CAS  Google Scholar 

  8. Pettit S, Irving M. The operative management of fistulous Crohn’s disease. Surg Gyn Obst 1988;167:223–228.

    PubMed  CAS  Google Scholar 

  9. Irving M. Assessment and management of external fistulas in Crohn’s disease. Br J Surg 1983;70:233–236.

    Article  PubMed  CAS  Google Scholar 

  10. Fazio V, Wilk P, Turnbull R, et al. Ileosigmoidal fistula complicating Crohn’s disease. Dis Colon Rectum 1977;20:381–386.

    Article  PubMed  CAS  Google Scholar 

  11. Wilk P, Fazio V, Turnbull R. Ileoduodenal fistula complicating Crohn’s disease. Dis Colon Rectum 1977;20:387–392.

    Article  PubMed  CAS  Google Scholar 

  12. McNamara M, Fazio V, Lavery I, et al. Surgical treatment of enterovesical fistulas in Crohn’s disease. Dis Colon Rectum 1990;33:271–276.

    Article  PubMed  CAS  Google Scholar 

  13. Greenstein A, Mann B, Aufses A. Free perforation in Crohn’s disease: a survey of 99 cases. Am J Gastroenterol 1985;80:682–689.

    PubMed  CAS  Google Scholar 

  14. Siminovitch J, Fazio V. Ureteral obstruction secondary to Crohn’s disease: a need for ureterolysis? Am J Surg 1980;139:95–98.

    Article  PubMed  CAS  Google Scholar 

  15. Homan W, Tang C, Thorbjarnarson B, et al. Acute massive hemorrhage from intestinal Crohn’s disease: report of seven cases and review of the literature. Arch Surg 1976;111:901–905.

    Article  PubMed  CAS  Google Scholar 

  16. Fazio V, Zelas P, Weakley F. Intraoperative angiography and the localization of bleeding from the small intestine. Surg Gyn Obst 1980;151:637–640.

    PubMed  CAS  Google Scholar 

  17. Greenstein A, Sachar D, Smith H, et al. A comparison of cancer risk in Crohn’s disease and ulcerative colitis. Cancer 1981;48:2742–2745.

    Article  PubMed  CAS  Google Scholar 

  18. Hawker P, Gyde S, Thompson H, et al. Adenocar-cinoma of the small intestine complicating Crohn’s disease. Gut 1982;23:188–193.

    Article  PubMed  CAS  Google Scholar 

  19. Greenstein A, Sachar D, Smith H, et al. Patterns of neoplasia in Crohn’s disease and ulcerative colitis. Cancer 1980;46:403–407.

    Article  PubMed  CAS  Google Scholar 

  20. Greenstein A, Janowitz A, Sachar D. The extraintestinal manifestations of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine 1976;55:401–412.

    Article  PubMed  CAS  Google Scholar 

  21. Lindor K, Fleming R, Ilstrup D. Preoperative nutritional status and other factors that influence surgical outcome in patients with Crohn’s disease. Mayo Clin Proc 1985;60:393–396.

    Article  PubMed  CAS  Google Scholar 

  22. Rombeau J, Barot L, Williamson C, et al. Preoperative total parenteral nutrition and surgical outcome in patients with inflammatory bowel disease. Am J Surg 1982;143:139–143.

    Article  PubMed  CAS  Google Scholar 

  23. Fisher K, Ross D. Guidelines for therapeutic decision in incidental appendectomy. Surg Gyn Obst 1990; 171:95–98.

    PubMed  CAS  Google Scholar 

  24. Kovalcik P, Simstein L, Weiss M, et al. Crohn’s disease and appendectomy. Dis Colon Rectum 1977;20:377–380.

    Article  PubMed  CAS  Google Scholar 

  25. Ruiz V, Unger S, Morgan J. Crohn’s disease of the appendix. Surgery 1990;107:113–117.

    PubMed  CAS  Google Scholar 

  26. Oren R, Rachmilewitz D. Preoperative clues to Crohn’s disease in suspected, acute appendicitis. J Clin Gastroenterol 1992;15:306–310.

    Article  PubMed  CAS  Google Scholar 

  27. Klein S, Greenstein A, Sachar D. Duodenal fistulas in Crohn’s disease. J Clin Gastroenterol 1987;9:46–49.

    Article  PubMed  CAS  Google Scholar 

  28. Pichney L, Fantry G, Graham S. Gastrocolic and duodenocolic fistulas in Crohn’s disease. J Clin Gastroenterol 1992;15:205–211.

    Article  PubMed  CAS  Google Scholar 

  29. Saint-Marc O, Vaillant J, Frileux P, et al. Surgical management of ileosigmoid fistulas in Crohn’s disease: role of preoperative colonoscopy. Dis Colon Rectum 1995;38:1084–1087.

    Article  PubMed  CAS  Google Scholar 

  30. Saint-Marc O, Tiret E, Vaillant J, et al. Surgical management of internal fistulas in Crohn’s disease. J Am Coll Surg 1996;183:97–100.

    PubMed  CAS  Google Scholar 

  31. Fazio V. Crohn’s disease of the small bowel-operative techniques and tactics. Hepato-gastroenterology 1990;37:56–62.

    PubMed  CAS  Google Scholar 

  32. Smedh K, Olaison G, Nystrom P, et al. Intraoperative enteroscopy in Crohn’s disease. Br J Surg 1993;80:897–900.

    Article  PubMed  CAS  Google Scholar 

  33. Lopez M, Cooley J, Petros J, et al. Complete intraoperative small bowel endoscopy in the evaluation of occult gastrointestinal bleeding using the sonde enteroscope. Arch Surg 1996;131:272–277.

    Article  PubMed  CAS  Google Scholar 

  34. Michelassi F, Testa G, Pomidor W, et al. Adenocar-cinoma complicating Crohn’s disease. Dis Colon Rectum 1993;36:654–661.

    Article  PubMed  CAS  Google Scholar 

  35. Baird D, Narendranathan M, Sandler R. Increased risk of preterai birth for women with inflammatory bowel disease. Gastroenterology 1990;99:987–994.

    PubMed  CAS  Google Scholar 

  36. Moeller D. Crohn’s disease beginning during pregnancy. S Med J 1988;81:1067.

    Article  CAS  Google Scholar 

  37. Woolfon K, Cohen Z, McLeod R. Crohn’s disease and pregnancy. Dis Colon Rectum 1990;33:869–873.

    Article  Google Scholar 

  38. Teahon K, Pearson M, Levi A, et al. Elemental diet in the management of Crohn’s disease during pregnancy. Gut 1991;32:1079–1081.

    Article  PubMed  CAS  Google Scholar 

  39. Nugent W, Rajala M, O’Shea R, et al. Total parenteral nutrition in pregnancy: conception to delivery. J Parent Enter Nutr 1987;11:424–427.

    Article  CAS  Google Scholar 

  40. Ribeiro M, Greenstein A, Yamazaki Y, et al. Intraabdominal abscess in regional enteritis. Ann Surg 1991;213:32–36.

    Article  PubMed  CAS  Google Scholar 

  41. Fazio V. Regional enteritis (Crohn’s disease): indications for surgery and operative strategy. Surg Clin North Am 1983;63:27–47.

    PubMed  CAS  Google Scholar 

  42. Post S, Betzler M, Ditfurth B, et al. Risks of intestinal anastomoses in Crohn’s disease. Ann Surg 1991;213:37–42.

    Article  PubMed  CAS  Google Scholar 

  43. Post S, Herfarth Ch, Schumacher H, et al. Experience with ileostomy and colostomy in Crohn’s disease. Br J Surg 1995;82:1629–1633.

    Article  PubMed  CAS  Google Scholar 

  44. Fazio V, Strong S. 1995. The surgical management of Crohn’s disease. In: Kirsner J, Shorter R. eds. Inflammatory bowel disease. 4th ed. Baltimore: Williams & Wilkins, 1995;830–887.

    Google Scholar 

  45. Keighley M. Surgical treatment of small bowel Crohn’s disease. In: Keighley M, and Williams N, eds. Surgery of the Anus, Rectum, and Colon. W.B. Saunders 1993;1710-1757.

    Google Scholar 

  46. Lock R, Farmer R, Fazio V, et al. Recurrence and reoperation for Crohn’s disease. The role of disease location in prognosis. N Engl J Med 1981;304:1586–1588.

    Article  PubMed  CAS  Google Scholar 

  47. Leitman I, Paul D, Shires G. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg 1989;209:175–180.

    Article  PubMed  CAS  Google Scholar 

  48. Fernandez-Banares F, Abad-Lacruz A, Xiol X, et al. Vitamin status in patients with inflammatory bowel disease. Am J Gastroenterol 1989;84:744–748.

    PubMed  CAS  Google Scholar 

  49. Andersson H, Bosaeus I, Fasth S, et al. Cholelithiasis and urolithiasis in Crohn’s disease. Scand J Gastroenterology 1987;22:253–256.

    Article  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer Science+Business Media New York

About this chapter

Cite this chapter

Casillas, S., Milsom, J.W. (1999). Small Bowel Resection. In: Michelassi, F., Milsom, J.W. (eds) Operative Strategies in Inflammatory Bowel Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1396-3_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-1396-3_18

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7130-7

  • Online ISBN: 978-1-4612-1396-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics