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Crohn’s Disease

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Intestinal Failure

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Abstract

Crohn’s disease is present in a large proportion of people with type II (medium term) and III (long-term) intestinal failure (IF). Data accumulated in large inflammatory bowel disease (IBD) and IF units have allowed for identification of, firstly, events that lead to IF in this patient group and, secondly, strategies to avoid such events. The most important observation is that while sequential loss of small bowel does occur in a number of patients, the leading cause of IF among people with Crohn’s disease is postoperative septic complications.

Many aspects of contemporary management have been shown to decrease the need for abdominal surgery overall. When surgery is needed, risk factors for septic complications have been identified and most of them are modifiable. Increased specialisation of IBD medicine and surgery is important, as are well thought out multidisciplinary clinical pathways to optimise the surgical candidate. The decision to perform a primary anastomosis is critically important. In patients with risk factors for septic complications, a primary anastomosis is best avoided and instead performed in a staged approach.

Intestinal failure in Crohn’s disease is treated similarly to other aetiologies. Definitive treatment, be it surgery to restore gastrointestinal continuity, home parenteral support (HPN) or novel therapies such as intestinal lengthening are best centralised to dedicated regional or national referral centres. The important goals for the referring hospital is to ensure rapid sepsis control and initiate safe parenteral nutrition.

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Authors and Affiliations

  1. Department of Inflammatory Bowel Disease and Intestinal Failure Surgery, Karolinska University Hospital & Karolinska Institutet, Stockholm, Sweden

    Mattias Soop

  2. National Intestinal Failure Reference Centre, Salford Care Organisation & University of Manchester, Manchester, UK

    Simon Lal

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  1. Mattias Soop
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Correspondence to Mattias Soop .

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  1. St Mark’s Hospital, Harrow, Middlesex, UK

    Jeremy M.D. Nightingale

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Soop, M., Lal, S. (2023). Crohn’s Disease. In: Nightingale, J.M. (eds) Intestinal Failure. Springer, Cham. https://doi.org/10.1007/978-3-031-22265-8_7

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  • DOI: https://doi.org/10.1007/978-3-031-22265-8_7

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