Questions Answered By Expert
Scott Strong, MD
Professor of Surgery at Northwestern University Feinberg School of Medicine
A: Intra-abdominal adhesions cause difficulties in a minority of patients. When problems do arise, they are typified by bouts of cramping pain, nausea, abdominal distention, and a change in bowel habits. Patients with Crohn’s disease can experience similar complaints when active disease affects the small intestine. It is important to distinguish between symptoms caused by adhesions and Crohn’s disease because the treatment is markedly different. An operation is currently the only way to disrupt symptomatic adhesions, but carries the risk of additional adhesions and is avoided when possible. A partial obstruction can sometimes be overcome with a low-residue diet because the foods in this diet are more easily broken down into smaller particles and contain less than 10 to 15 grams of fiber each day. Foods included in a low-residue diet are cooked vegetables, fruits, meats, and white breads. Raw vegetables, beans, legumes, nuts, seeds, and whole grains are avoided. With the right food choices, a low-residue diet contains an adequate amount of nutrition, but some supplements (calcium, folic acid, vitamin C) are recommended if the diet is followed for an extended period of time. hide answer
A: These blockages can be sometimes managed with dilatation using a colonoscope, especially if they are less than 2 inches in length and not associated with any abscess or fistula. If this approach is unsuccessful or inappropriate and the stricture is causing symptoms, an operation can be performed to remove the segment of narrowed intestine. Strictures caused by scarring without associated inflammation are usually unresponsive to medications. hide answer
A: Crohn’s disease can cause structuring anywhere along the intestinal tract including where the rectum meets the muscles that provide control over bowel motions. A stricture at this level is generally treated with dilatation sometimes in combination with steroid injections into the site. The patient is then encouraged to use products that promote a well-formed stool that acts to dilate the area as it passes through. In rare instances, the stricture can be managed by excising a short area of narrowing and reconnecting the two ends of bowel usually in combination with a temporary ileostomy or colostomy. An anoplasty flap is generally not appropriate because the stricture is not close enough to the skin surrounding the anus to allow such an operation to be successfully performed. hide answer
A: The segment that was removed should provide ample material to confirm a diagnosis of Crohn’s disease. Imaging studies such as CT or MR enterography can be used to visualize the remaining small intestine as can some forms of advanced endoscopy. Your symptoms may be caused by extensive inflammation in some of the remaining small bowel. If this disease cannot be managed with medical therapy, surgical treatment can be employed whereby the involved segments can be widened without removal of any intestine using a procedure called a strictureplasty. Operations in these more complicated scenarios are sometimes best performed by a surgeon experienced with the surgical treatment of Crohn’s disease. hide answer
A: Any operation on the abdomen is associated with risks during the immediate period following the operation as well as the long-term risk (5%) for blockage of the small bowel secondary to scar tissue creating adhesions. The small intestine is responsible for absorbing nutrients from the foods we consume, and an adequate length of small bowel is needed to ensure that an oral diet can maintain a healthy state of nutrition. In patients with Crohn’s disease, repeated operations to remove segments of the small intestine can result in a condition called short-bowel syndrome that sometimes requires TPN to supplement the patient’s nutrition by direct delivery of nutrients into the blood stream. Although operations for Crohn’s disease are generally avoided unless medical therapy is deemed inappropriate or ineffective for a variety of reasons, several procedures such as strictureplasty can be used as an alternative to removal of the small intestine in an attempt to prevent the development of short-bowel syndrome hide answer