Intestinal Obstruction

Intestinal obstruction most commonly occurs in patients with Crohn's disease. Small bowel obstruction is the most common complication requiring surgical correction in Crohn's disease and affects 35-54% of patients [37, 38]. It is important to rule out a malignancy whenever a stricture, especially colonic, is present. The initial management of intestinal obstruction in Crohn's disease is medical therapy. Obstruction that is unresponsive to medical treatment requires resection or possible strictureplasty [39]. Septic problems or phlegmon, a stricture close to a planned resection and extensive ulceration or bleeding are contraindications for strictureplasty. Ileocecal resection is a very satisfactory procedure since most patients enjoy longstanding good health after this procedure. "Don't operate until a patient gets a complication from Crohn's disease; but don't wait for a complication to become further complicated" [40]. Extended resection margins confer no advantage to patients in reducing cumulative recurrence rates. The presence of residual microscopic Crohn's disease at resection margins does not increase recurrence rates vs. normal margins. Resection margins of 2 or 12 cm after a median follow-up of 56 months had the same recurrence rate [41].

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