VM21 - Crohn's Disease Can Spread Without Timely Surgery

Purpose/Background: As the options for medical management of inflammatory bowel disease increase, many patients are being referred to surgeons after a longer disease duration. However, without timely surgery, Crohn's disease can spread throughout the abdomen and pelvis, leading to complications and complex surgeries that may have otherwise been avoided.

Methods/Interventions: This video explores that case of a 47 year old female with a 30 year history of crohn's disease. At the time of her initial diagnosis, she had isolated ileocolic disease. Unfortunately, her crohn's was not well controlled and over time developed into severe penetrating disease. In this video, we demonstrate the proper method to run the bowel in order to assess for fistulas and/or stricturing disease. We also identify areas of active disease versus healthy areas of bowel targeted by fistulas. This bowel can be saved in order to minimize resection and, therefore, the risk for short bowel.

Results/Outcomes: In total, this patient required eight fistula repairs. In order to allow for proper healing, a proximal jejunostomy was created. To account for the high losses expected from this proximal stoma, she will require home TPN until the time of stoma closure. This is not a benign intervention, but the benefits outweigh the risks.

Conclusion/Discussion: Timely referral to a surgeon may have prevented the need for complicated surgery in this patient. With so many medication options, it can be difficult for gastroenterologists to know when to cease medical treatment and refer to surgery. This time lapse can lead to worsening care. This patient experience highlights the importance of coordinate care in a multidisciplinary inflammatory bowel disease center.