When is surgical intervention for Crohn disease indicated, and what if pharmacotherapy or nutritional therapy is ineffective or unadaptable for those with active colonic disease?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

If medical therapy for active Crohn disease fails, surgical resection of the inflamed bowel, with restoration of continuity, is indicated. Urgent surgery may be required in rare cases of sustained or recurrent hemorrhage, perforation, abscess, and toxic megacolon. Partial small bowel obstruction or intra-abdominal abscess may sometimes be treated conservatively with intravenous (IV) hydration, nasogastric suction, and parenteral nutrition if there is no evidence of ischemia. [2, 85]

If pharmacotherapy or nutritional therapy is ineffective or unadaptable for those with active colonic disease, the combination with granulocyte monocyte apheresis may be considered. [12]


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