Editing Crohn's disease (section)

=== Obstruction ===

* Much more common in CD than UC - intermittently - can be inflammatory/fibrotic stricture, but can also be adhesive due to previous surgery
* Aetiology
** Secondary to an acute exacerbation of active disease
*** Typically improve with medical management (IV corticosteroids)
** Secondary to chronic fibrosing lesions (most patients with complete SBO fall into this group)
*** Most commonly TI
*** Trial non-op - often partial obstruction
**** No benefit to steroids - often require surgery - complete obstruction often requires resection
**** If doubt over presence of acute inflammation, can do faecal calprotectin
*** Look to intervene if no improvement in 48 hours, according to Schein
**** Operation of choice is segmental resection and primary anastomosis
**** Consider stricturoplasty - when bowel resection is inappropriate due to risk of short bowel syndrome in patients with extensive fibro-stenotic disease, or in patients with multiple short-segment strictures over a longer area of bowel, several previous bowel resections, and in those with chronic fibrous obstruction. Complication and recurrence rates are comparable to resection with anastomosis in this setting.
****
**** Endoscopic dilation - initial success rate 90% for fibrotic strictures however 75% of patients require further dilation
**** Needle-knife stricturotomy can also be used - not widely-accepted yet
**** Large bowel strictures, particularly UC, raise concern for malignancy. Do a full oncologic resection if operating in this setting. Stricturoplasties are not recommended in colon.