Crohn disease is a transmural inflammatory process that can affect any area of the GI tract, from the mouth to the anus. It has a female predominance. The disease has a segmental distribution, with normal mucosa interspersed between diseased areas of bowel. Common symptoms include diarrhea, abdominal pain, nausea and vomiting, weight loss, and fever. There can be signs of an abdominal mass or perianal fistulas on physical examination. The terminal ileum is involved in up to 45% of patients at presentation. Common pathologic changes include fissures and fistulas, transmural inflammation, and granulomas. Grossly, the mucosa shows aphthoid ulcers that often deepen over time and are associated with fat wrapping and bowel wall thickening. As the disease progresses, the bowel lumen narrows, and obstruction or perforation may result. Over time, the areas of stricture may develop dysplastic or even neoplastic changes.
Surgical management
Surgical management of Crohn disease is limited to resection of the diseased segment of intestine responsible for the complication. Resection is bounded by grossly normal margins; no attempt is made to obtain microscopically negative margins because outcome and recurrence are unaffected by this. If significant intra-abdominal infection or inflammation is encountered during surgery, a proximal ostomy is created to allow complete diversion of intestinal contents and resolution of the initial process. If no infection or inflammation is encountered, normal-appearing bowel can be primarily anastomosed. Stricturoplasty to preserve small-bowel length is favored by some groups, with single-institution retrospective reviews demonstrating comparable recurrence rates to resectional treatment