Crohn’s Disease

What is Crohn’s Disease? 

Crohn’s disease is a type of inflammatory bowel disease that can involve the entire gastrointestinal tract from mouth to anus. It typically occurs in a patchy manner and can cause ulceration, strictures and transmural (all layers) inflammation of the small and large bowel resulting in perforation, obstruction or fistulae. If the anus is affected, fissures, fistula and chronic discharge may be present. Males and females are affected equally. The disease may present at any age but there is a slightly increased peak of incidence around 25 and 65 years of age.

Causes of Crohn’s Disease

The cause is unknown but several theories exist. 

Symptoms of Crohn’s Disease

• Rectal bleeding 

• Bloody diarrhoea 

• Abdominal pain 

• Fever, chills, tiredness 

• Extra-intestinal symptoms include: liver disease, eye inflammation, arthritis and skin lesions 

What is the management of Crohn’s Disease

• A consultation with your GP and subsequent referral to a colorectal surgeon will ensure that your symptoms are appropriately assessed and treated 

• Diagnosis of Crohn’s is based on the clinical picture, the appearance of bowel inflammation at colonoscopy, biopsy confirmation and small bowel imaging e.g. MRE, barium studies.

When is surgery for Crohn’s Disease indicated

• Medical treatment fails to control the symptoms / persistent chronic disease state

• Presence of complications e.g. severe haemorrhage, toxic colon, bowel perforation, obstruction, fistula disease, abdominal sepsis 

• Cancer or large area of high grade dysplasia, unmanageable endoscopically

Who should do my surgery? 

• The decision to operate is always made by the patients physician and surgeon in consultation. It is very important that the surgeon is familiar with all aspects of Crohn’s Disease and is skilled in the full range of available surgical techniques. Members of CSSANZ have these skills, and they are trained in the long term support and follow-up of patients who have surgery for Crohn’s disease.

What surgery might I have?

• Bowel resection is tailored to the specific problem and location of the diseased segment. 

• A stoma of either large bowel or small bowel is sometimes needed and this can be permanent if the anus is removed. 

• ~50% of patients who require surgery have a second surgery at some stage in the future, often years later. 

Prospect of patients with Crohn’s Disease

• Patients with chronic inflammation in the colon or stricturing disease should undergo long term surveillance +/- surgical resection because of an increase risk of bowel cancer.