Severe inflammatory bowel disease may not improve with medicine. Your doctor may recommend surgery to remove inflamed sections of the bowel.
Surgery does not cure Crohn disease. The inflammation may return to a different section of the intestine or close to the area of intestine that was removed. If an obstruction (blockage) or fistula (abnormal connection between the intestine and other organs or tissues) develops, surgery may be needed to remove or repair the area. Because surgery is not curative, you should weigh the pros and cons carefully. Get as much information as possible from your doctor and the nurses who support patients through these surgeries.
Removal of the entire colon, rectum, and anus can remove the threat of colon cancer and eliminate ulcerative colitis. Most often, surgery is recommended when medicines have failed and serious complications of the disease are present. Surgery may also be recommended to reduce your risk of colon cancer, especially if you have had ulcerative colitis for more than 10 years. Make sure you understand all the risks and benefits of each option before proceeding with surgery.
Surgical options include the following:
Proctocolectomy is the surgical removal of the entire colon, rectum, and anus. This is done to treat ulcerative colitis.
Since your colon and rectum are essential for the movement and excretion of waste, a new way for wastes to be removed from your body will be created. This can be done by any of the following methods:
Ileostomy —An ileostomy is an artificial opening (called a stoma) in the abdomen. The last portion of the small bowel, called the ileum, is brought out to the surface of the abdominal wall, allowing waste to drain into a sealed pouch on the outside of the body. You will need to wear an ostomy bag on the outside of your body to collect the waste. Before you leave the hospital, a nurse will teach you how to care for your ostomy.
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Continent ileostomy —For this type of ileostomy, the surgeon may use the end of the ileum to create a pouch inside the lower abdomen to collect waste. An opening is also created in the abdominal wall. To empty the pouch, a tube is inserted manually into the opening in the abdominal wall. No external appliance is required. If this surgery is chosen there is a risk of pouchitis (inflammation of the pouch), which can usually be controlled with medication.
Ileoanal anastomosis —In this surgery, the colon and rectum are removed but the anal sphincters are preserved. The end of the ileum is then formed into a pouch and connected to the anus. Waste can then flow though the ileum to the anus and out of the body. This surgery is usually done in 2 stages, requiring a temporary ileostomy until the newly formed rectum can heal and the ileum can be connected to the anus. This option also carries a risk of pouchitis and leakage of feces.
A colectomy is done to remove the colon, but preserves part of the rectum. The ileum is then connected to the rectum allowing bowel movements to come out through the rectum. Although continence is preserved with this technique, leaving part of the diseased rectum puts people at risk of recurrent symptoms. For this reason, this operation is not often done.
Crohn disease in adults. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/crohn-disease-in-adults. Updated May 16, 2018. Accessed December 21, 2018.
IBD. American Gastroenterological Association website. Available at: https://www.gastro.org/practice-guidance/gi-patient-center/topic/inflammatory-bowel-disease-ibd. Accessed December 21, 2018.
Surgery for Crohn's disease & ulcerative colitis. Crohn's & Colitis Foundation of America website. Available at: http://www.crohnscolitisfoundation.org/resources/surgery-for-crohns-uc.html. Accessed December 21, 2018.
Ulcerative colitis in adults. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/ulcerative-colitis-in-adults. Updated October 26, 2018. Accessed December 21, 2018.
Last reviewed September 2018 by EBSCO Medical Review BoardDaus Mahnke, MD Last Updated: 11/24/2020