Surgical

Surgical management should be considered where there is failure of medical management, particularly where this results in growth failure.

There is evidence to suggest that appropriate early surgery results in reduced symptoms and increased growth.

NICE have stated that surgery in Crohn's disease may be indicated if the disease is limited to the distal ileum. Also balloon dilatation may be indicated (2)

• Crohn's disease limited to the distal ileum
  
  
  • surgery as an alternative to medical treatment
    • consider surgery as an alternative to medical treatment early in the course of the disease for people whose disease is limited to the distal ileum, taking into account the following:
      • benefits and risks of medical treatment and surgery
      • risk of recurrence after surgery
      • individual preferences and any personal or cultural considerations
        
        
  • surgery early in the disease
    • consider surgery early in the course of the disease or before or early in puberty for children and young people whose disease is limited to the distal ileum and who have:
      • growth impairment despite optimal medical treatmentand/or
      • refractory disease
        
        
• balloon dilation
  • consider balloon dilation particularly in people with a single stricture that is short, straight and accessible by colonoscopy.

Reference:

• (1) NICE (October 2012). Crohn's disease Management in adults, children and young people