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Operative management of Crohn disease of the small bowel and colon

Martin Weiser, MD
Section Editor
David I Soybel, MD
Deputy Editor
Wenliang Chen, MD, PhD


Crohn disease is most often located at the terminal ileum but can potentially involve the entire gastrointestinal tract as a chronic, diffuse, recurring disease that is not curable by a surgical resection. Operative management is reserved for patients who develop complications or have disease refractory to medical therapy and can alleviate symptoms, address serious complications, improve quality of life, and, in some settings, be lifesaving [1,2]. As many as one-half of patients with Crohn disease require at least one surgical procedure during the course of their disease and, if diagnosed and medically treated early in the course of disease, the need for surgical intervention within the first two years of diagnosis has decreased in some settings [3]. In a large national population-based study, the increasing use of thiopurine was associated with a significant reduction in the rate of first intestinal surgery, and prolonged use of these medications was independently associated with a reduced requirement for surgery in the long term [4]. Whether more aggressive medical therapy will decrease the requirement for operative interventions in the future remains to be proven [5-7]

This topic will review the surgical management of patients with small bowel and colonic Crohn disease. The management of patients with Crohn disease of the rectum and anus is reviewed separately. (See "Perianal complications of Crohn disease".)


A bowel resection is performed when segments are actively or subacutely inflamed or perforated, or when there is an abscess or fistula to an adjacent organ.

The major indications for surgical management include [8,9]:

Fibrotic stricture with obstruction


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Literature review current through: Sep 2016. | This topic last updated: Jan 13, 2016.
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