By Dr Ananya Mandal, MD
Crohn’s disease is associated with two major complications. One of them is obstruction of the intestinal tube due to severe swelling and inflammation of the inner linings.
The other is formation of a fistula. A fistula is an abnormal channel that develops between the end of the bowel or rectum and the skin around the anus.
Obstruction of bowel
With inflammation, the insides of the intestinal wall swell and over time repeated flare ups leaves the walls of the intestines hardened.
Normally the pliable walls of the tube like intestines contain muscles that lead to propulsion of food by alternative contractions and relaxations.
Due to hardening of the walls the food in the intestines get blocked at the affected areas as the contraction waves fail to pass though.
The commonest presentation of bowel obstruction is inability to pass stools or passing watery stools. There may be vomiting, severe abdominal pain, bloating of the abdomen and feeling of fullness.
Bowel obstruction is a medical emergency and needs immediate treatment. If left untreated, there is a risk that the bowel could rupture spilling the contents and bacteria of the gut into the abdominal cavity. This is life threatening as it leads to severe internal bleeding and widespread infection. Death is almost certain if not corrected on an urgent basis.
Bowel obstruction is treated using surgical repair methods. Initially, however, an all liquid nutritious diet may be tried to prevent further obstruction or relief of the obstruction.
The surgery usually employed is called a temporary colostomy that is performed to allow the affected areas to heal.
In this operation a section of the colon is diverted and attached to an opening in the abdominal wall called the stoma. The Stoma is attached to a pouch to collect the waste material.
Once the bowel is healed a repeat operation is performed to reattach the colon. If the attacks are repeated and frequent a permanent colostomy may be performed.
An ileostomy operation may also be undertaken. Here a section of the small bowel is diverted and attached to the stoma.
With inflammation there may be development of ulcers within the inner walls of the intestines. This leads to thinning of the walls and finally formation of perforations.
The perforations may turn into tunnels that run from one part of the digestive system to another or, in some cases, to the bladder, anus or skin. These are called fistulas.
Initially fistulas may cause no symptoms especially if they are small. Larger fistulas can become infected and lead to pain, fever and presence of blood or pus in the stools.
Fistulas that open over the skin around the anus may give out foul smelling discharge.
Surgery is usually required to repair a fistula. During the operation the fistula is cut open and cleared of its contents and allowed to heal as a flattened scar.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)