Disease Recurrence After Surgery
Recurrence of Crohn's disease is very common after any procedure. One expert described the risk as being between 7 - 25% for each year after resection, with an average risk of 50% at 5 years after resection. (Even if the entire colon is removed there is still a high chance of recurrence in the rectum and a somewhat lower risk for recurrence in the small intestine.)
Patients at highest risk for recurrence include:
- Smokers
- Those whose disease occurred in the ileum (the lowest part of the small intestine) and colon
- Those with abscesses or fistulas
- Those have had previous surgeries
Various drugs are used to prevent recurrence. They include the antibiotic metronidazole (Flagyl), mesalamine, infliximab, and mercaptopurine. These drugs can have severe side effects. And, it is not clear if these or any other drugs are effective in preventing recurrence. Even if medications can help prevent recurrence in some patients, it is not yet known who these individuals might be. (In any case, steroids do not appear to help prevent recurrence.)
Emergency Surgeries
In some cases, surgery is needed for emergency conditions that can occur with Crohn's disease. Emergency surgery is used to:
- Stop severe intestinal bleeding
- Clear small bowel obstruction
- Drain and heal abscesses or fistulas
- Repair perforation
Small Intestine Transplantation
Procedures for transplanting the small intestine in patients with intestinal failure are under investigation. These are still experimental and are being tested in patients who have lost so much of their small intestine that they must rely on total parenteral nutrition (intravenous administration of nutrition). Small-bowel transplantation is a more difficult procedure than some other transplants, because of the high rate of potential complications, including infection and organ rejection. Patients who have transplants must be on immunosuppressant drugs for the rest of their lives. Furthermore, there is some evidence that Crohn's disease recurs in the transplanted bowel.
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