Crohn's Disease

Which Crohn's Disease complications are most serious?

Formation of abscesses and fistulae are two of the most ominous complications of severe Crohn's disease. Abscesses most commonly occur intra-abdominally in the region of the terminal ileum. They may form between loops of small intestine, within the mesentery, between the serosa of the small bowel and the parietal peritoneum, or at the site of a surgical anastomosis. Abscesses occur in approximately 15 to 20 percent of patients with Crohn's disease. Patients most often present with fever, abdominal pain, and leukocytosis.

The diagnosis is best confirmed with abdominal CT scan and treated with intravenous antibiotics and internal or external drainage. Fistulae occur in 20 to 40 percent of patients, developing when an abscess penetrates into another loop of small bowel (enteroenteric), a loop of large bowel (enterocolonic), the parietal peritoneum (enterocutaneous), or other viscera (enterovesical, enterovaginal, etc.). Fistulae occur during periods of active disease and usually persistwhen disease is in remission. Diagnosis is made with contrast barium studies. Drainage depends on the character of the fistulae. Symptomatic fistulae frequently respond to immunosuppressive therapy. Surgical resection (fistulectomy) should be reserved for severe symptomatic fistulae unresponsive to immunosuppressive therapy.

Patients with chronic Crohn's disease may also develop intestinal strictures, causing partial or complete bowel obstruction; these strictures may be a result of acute inflammation with mucosal thickening in a previously scarred and narrowed loop of bowel. Adhesions resulting from prior surgery may also cause obstruction. Treatment involves decompression, nothing by mouth, IV hydration, and surgical consultation. Patients can develop a number of perianal complications, such as hemorrhoids, fissures, abscesses, and fistulae. There is an increased incidence of colon carcinoma in patients with long-standing Crohn's disease, and colonoscopic surveillance should begin after 10 years if Crohn's disease involves the colon.

How good is the current long-term prognosis of Crohn's Disease?

The overall long-term prognosis in Crohn's disease is worse than for patients with ulcerative colitis. In addition, Crohn's disease becomes more severe and progressive over time. Surgery is not curative in Crohn's disease, as it is in ulcerative colitis. Approximately one third of patients with Crohn's disease require surgery within the first five years of diagnosis. Overall quality of life is poorer for patients with Crohn's disease than for patients with ulcerative colitis, and those Crohn's disease patients who have required surgical intervention have the poorest quality of life. Long-term mortality is approximately 10 percent. However, many patients respond well to drug therapy, remaining symptom-free for extended periods of time.

Last updated Jan 4/07