Surgical options of IBD patients

Long term patients of Inflammatory Bowel Disease are prone to worsening flare ups, chronic pain, and colon cancer. Over three quarters of Crohn’s patients and over one fourth of ulcerative colitis patients opt into surgery as either a temporary remedy or, if removing the entire colon, as a cure. 

In ulcerative colitis, patients have the option of removing just the infected section of the colon or removing the entire colon and rectum. In majority of cases, the entire colon and rectum are removed in a colectomy. Originally the only option after this was to attach the small intestine to the abdominal wall in a colostomy. The small intestine would then deposit into a small bag. While odorless and easy to hide, there were obvious concerns with the fecal bag. A new approach had an internal bag made up of small intestine epithelium which acts as a rectum, holding stool until it can be removed with a tube through the hole in the abdominal wall. The most recent surgical procedure to be approved for ulcerative colitis patients is an ileo-anal anastomosis, where the large intestine and rectum are fully removed and the small intestine is connected directly to the anus where sphincters are still able to regulate bowel movements normally. Some reported cases of inflammation near the anastomosis indicate that left over rectal muscle remained, which can still be affected by the ulcerative colitis. Some people still lack entire regulation. The primary complaint is that without a large intestine, the stool is never properly dried and patients report diarrhea, but this can be avoided with a proper diet. 

With Crohn’s disease, surgery is more of a temporary remedy. Since it occurs throughout the entire G.I. tract, it is not as simple as simply removing the diseased tissue. Even if the disease only shows up in the colon originally, removal of the colon would not necessarily remove the disease. Out of all the patients that opt into surgery, half of them will have new lesions in previously healthy parts of the tract. The most common colectomy done on Crohn’s patients is removal of the sigmoid section of the colon, because this is the highest risk area for colon cancer and Crohn’s disease is known for causing colon cancer. Other patients have sections of their small intestine removed if the area is so inflamed that it is causing obstructions to the stool. The primary surgery chosen by Crohn’s patients is to repair ulcerative tissue. This involves removing the small area which has ruptured, cleaning out abscesses and pus, and reattaching internal fistula. 

Surgery is not what gastroenterologists go to first. Because of its low overall success rate, patients are generally steered toward medication until there are such problems as ruptured G.I. tract, hemorrhaging or colon cancer.

“Bowel Diversion Surgeries: Ileostomy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy” MedicineNet. http://www.medicinenet.com/bowel_diversion_surgery_ileostomy_colostomy/article.htm

“Inflammatory Bowel Disease.” Center for Disease Control and Prevention, 15 July 2011. http://www.cdc.gov/ibd/ 

Wax, Arnold. “Living with Colostomy.” Colorectal Cancer Health Center, WebMD, 1 June 2012. http://www.webmd.com/colorectal-cancer/guide/living-colostomy