Surgery Definition – What is Crohn’s disease?
Surgery Definition – What is Crohn’s disease?
Crohn’s disease is also known as regional enteritis which affects any part of the bowel from the mouth to anus. Rectal sparing is common. Bimodal incidence and peak twice in a lifetime of the individuals. Common in the age range of 25 – 40 and 50 -65. Common in female than male. May occurs due to environmental factors or autoimmune disorders.
Pathologically Crohn’s disease is associated with non caseating granuloma with full thickness involvement ( transmural). There is a transverse fissure with deep ulcers and distortion of the crypt. There will also be swollen mucosa (cobblestone appearance with skip lesion) Rectal may not be affected but mouth and anus are common. There will be a serosal fat encroachment with fibrosis and stricture.
Symptoms and signs of Crohn’s disease may include weight loss, anorexia and malaise. There will be fissure, ulceration, fistula which occur in the anal region which lead to watering can perineum. Other signs may include fibrosis, stricture, colitis and bloody diarrhea which may lead to chronic obstruction. Terminal ileitis may present with similar characteristic as appendicitis. Fistulae may also occur such as enterovaginal fistula, enterocystic fistula and enterocutaneous fistula
The investigation for Chron’s disease may include full blood count which may reveal anemia, increase in white blood cell count, raise ESR and CRP and reduction in albumin in acute setting.
Radiological imaging may include Barium studies which may reveal skips lesion, rosethorn ulcers, cobblestone appearance and Kantor’s string sign or narrowed segment of bowel with proximal dilation. Endoscopy is considered to identify the extent of distribution of the disease and for biopsies taking. Culture of the stool is considered to rule out infective colitis.
The treatment of Chron’s disease may focus on medical treatment such as anti inflammatories which include oral 5 aminosalicyclic acid preparation such as sulphsalazine or mesalazine, steroids such as prednisolone and antibiotics such as metronidazole with the aim to treat any complications. Steroids and anti inflammatories agents may be considered both topically or as enema.
Surgical treatment is considered in cases of failure of medical management or complication of Crohn’s disease such as perforation and fistulae. Surgery should be avoided as it may lead to high risk of sepsis post operation or further fistulae. Multiple laparotomies are considered for segmented resection of bowel, resection of the bowel or stricturoplasty.
Crohn’s disease is also known as regional enteritis which affects any part of the bowel from the mouth to anus. Rectal sparing is common. Bimodal incidence and peak twice in a lifetime of the individuals. Common in the age range of 25 – 40 and 50 -65. Common in female than male. May occurs due to environmental factors or autoimmune disorders.
Pathologically Crohn’s disease is associated with non caseating granuloma with full thickness involvement ( transmural). There is a transverse fissure with deep ulcers and distortion of the crypt. There will also be swollen mucosa (cobblestone appearance with skip lesion) Rectal may not be affected but mouth and anus are common. There will be a serosal fat encroachment with fibrosis and stricture.
Symptoms and signs of Crohn’s disease may include weight loss, anorexia and malaise. There will be fissure, ulceration, fistula which occur in the anal region which lead to watering can perineum. Other signs may include fibrosis, stricture, colitis and bloody diarrhea which may lead to chronic obstruction. Terminal ileitis may present with similar characteristic as appendicitis. Fistulae may also occur such as enterovaginal fistula, enterocystic fistula and enterocutaneous fistula
The investigation for Chron’s disease may include full blood count which may reveal anemia, increase in white blood cell count, raise ESR and CRP and reduction in albumin in acute setting.
Radiological imaging may include Barium studies which may reveal skips lesion, rosethorn ulcers, cobblestone appearance and Kantor’s string sign or narrowed segment of bowel with proximal dilation. Endoscopy is considered to identify the extent of distribution of the disease and for biopsies taking. Culture of the stool is considered to rule out infective colitis.
The treatment of Chron’s disease may focus on medical treatment such as anti inflammatories which include oral 5 aminosalicyclic acid preparation such as sulphsalazine or mesalazine, steroids such as prednisolone and antibiotics such as metronidazole with the aim to treat any complications. Steroids and anti inflammatories agents may be considered both topically or as enema.
Surgical treatment is considered in cases of failure of medical management or complication of Crohn’s disease such as perforation and fistulae. Surgery should be avoided as it may lead to high risk of sepsis post operation or further fistulae. Multiple laparotomies are considered for segmented resection of bowel, resection of the bowel or stricturoplasty.