Surgical Management of Crohn's Disease
Publication Date: July 1, 2020
Last Updated: April 18, 2022
Recommendations
OPERATIVE INDICATIONS
Medically Refractory Disease
1. Patients who demonstrate an inadequate response to, develop complications from, or are nonadherent with medical therapy should typically be considered for surgery. (1C)
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Inflammation
1. Patients with severe acute colitis who do not adequately respond to medical therapy or who have signs or symptoms of impending or actual perforation should undergo surgery. (1C)
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Stricture
1. Endoscopic dilation may be considered for patients with short-segment, noninflammatory, symptomatic small-bowel or anastomotic strictures. (1C)
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2. Surgery is indicated for patients with symptomatic small-bowel or anastomotic strictures that are not amenable to medical therapy and/or endoscopic dilation. (1C)
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3. Patients with strictures of the colon that cannot be adequately surveyed endoscopically should be considered for resection. (1C)
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Penetrating Disease
1. Patients with a free perforation should undergo surgical resection of the perforated segment. (1B)
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2. Patients with penetrating Crohn’s disease with abscess formation may be managed with antibiotics with or without drainage followed by interval elective resection or medical therapy depending on the clinical situation and patient preferences. (2B)
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3. Patients with enteric fistulas that persist despite appropriate medical therapy should be considered for surgery. (1C)
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Hemorrhage
1. Stable patients with gastrointestinal hemorrhage may be evaluated and treated by endoscopic and/or interventional radiologic techniques. Unstable patients, despite resuscitation efforts, should typically undergo operative exploration. (1C)
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Overview
Title
Surgical Management of Crohn's Disease
Authoring Organization
American Society of Colon and Rectal Surgeons