In their lifetimes, most patients with Crohn’s disease undergo a combination of medical and surgical treatments. Some will require the services of an ileostomy surgeon. Understanding how these doctors can help is a key to reducing patient stress and anxiety.
Crohn’s is one of the two main inflammatory bowel diseases. The other is ulcerative colitis. According to the Crohn’s & Colitis Foundation of America (CCFA), this digestive disorder affects around 700,000 U.S. patients and typically appears between ages 15 and 35. Although it can strike any portion of the digestive tract, the small and the large intestines are the most common sites.
The specific cause remains unknown, though experts suspect a faulty immune system. As many as 20 percent of patients have a close relative with this disorder. Gastroenterologists prescribe medications that are anti-inflammatories, corticosteroids, antibiotics, immunosuppressants, biologic therapies, or a combination of these drugs to control disease flares. However, individuals often require surgery, sometimes more than once.
When medication cannot control Crohn’s disease, surgery is the remaining alternative. According to the University of Maryland Medical Center, surgery treats issues such as:
Surgical patients usually undergo treatment from a colorectal surgeon to remove a diseased portion of intestine. Sometimes the physician is a general surgeon. The surgeon connects the remaining portions of the bowel in a procedure known as a resection and anastomosis. When the surgeon cannot reconnect any remaining bowel into one piece, the choice might be to create an ostomy. This could be temporary or permanent.
For Crohn’s patients with extensive disease in the large intestine, it is necessary to remove the colon and rectum in a procedure known as a proctocolectomy, CCFA explains. Removal of the colon only is a colectomy. The surgeon creates an ileostomy to allow waste to pass through the abdomen, changing the way the patient has a bowel movement.
There are two general types of ileostomy. With the standard procedure, a surgeon removes the colon, rectum, and anus, then brings the end of the small intestine through the abdominal wall. The external opening through which liquid stool passes is called a stoma. A removable pouch collects waste.
A continent ileostomy is the second type. Patients with this procedure do not wear any type of appliance, BCIRhistory.com reports. Two examples are the Koch Pouch and the more recent Barnett Continent Intestinal Reservoir. Both of these types of surgery use the small bowel itself as a reservoir for collecting stool. The patient is able to insert a catheter or tube to empty the reservoir.
After a proctocolectomy, a standard ileostomy is normally the only choice for Crohn’s patients. This is due to risk factors for disease recurrence and complications like strictures, fistulas, and abscesses.