Disorders of the Gastrointestinal System, 2nd Edition
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Endoscopic dilation When the small intestine is affected by Crohn’s disease, portions of the diseased intestine alternate with portions of the normal bowel. The affected areas thicken and narrow, forming strictures that may in- terfere with the passage of digested food and cause obstruction. Dilation is used to widen this opening to allow food to pass more easily and avoid obstruction. Resection In the event of a particularly long stric- ture or inflamed area of the bowel, or if there are many strictures close to each other, the surgeon may need to remove the affected area of the intestine. The two ends of the normal or unaffected intes- tine are joined together (anastomosis). A resection may provide many years of relief from the symptoms of the disease. Unfortunately, the disease can reoccur at or close to the anastomosis site, so as lit- tle of the intestine is removed as possible. Colectomy (removal of the colon) or proctocolectomy (removal of both colon and rectum) Patients with severe disease that affects the colon may need to have the entire co- lon removed. If the rectum is unaffected, the surgeon may join the end of the small intestine to the rectum, thus allowing stool passage through the rectum. How- ever, if the rectum is affected and both the colon and rectum are removed, the patient will require an ileostomy and must wear an external pouch to collect body waste. Abscess drainage About 70% of Crohn’s-related abscess- es can be drained percutaneously. Surgi- cal drainage may be required if this is in- effective, especially in cases of abscesses within the abdominal wall.
is present. They should be used only short term, as they increase the risk for toxic megacolon. ● Encouraging adequate rest to facilitate bowel healing. Patients may need to be on a clear liquid diet during a flare to allow damaged tissue to begin healing. Sometimes, especially with children, parenteral feeding may be necessary. ● Implementing dietary changes. Foods that exacerbate flare symptoms or cause irritation vary from patient to patient. However, foods commonly found to be irritating and thus may need to be removed from the diet, including dairy products, spicy foods, vegetable skins, nuts, popcorn, caffeine, and carbonated beverages. | NURSING ALERT Even if the diseased section of the intestine is surgically removed, the inflammation can reoccur in a previ - ously unaffected segment of the in- testine. About 50% of adults who un- dergo resection have a reoccurrence of Crohn’s disease within five years of surgery (Ozgur et al., 2021). Medications and supportive measures are the first interventions for patients experiencing Crohn’s disease. Never- theless, approximately 70% of patients with Crohn’s disease eventually require surgical intervention. Surgery is indicat- ed to correct bowel perforation in cases of massive hemorrhage, fistulas, acute intestinal obstruction, or toxic megaco- lon—or for patients who do not respond to medication and supportive measures (Ghazi, 2019). There are several surgical options for the patient with Crohn’s dis- ease (Fleshner, 2022).
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