Surgical aspects of Crohn's diseases.

There is no other abdominal disease with so frequent and diverse complications as Crohn's disease. One of the most frequent complications is ileus (45%) due to the deflection and stricture of a bowel segment caused by inflammation and granulation. Fistulas--often multiple--between the involved bowel segment(s) and the hollow organs are also frequent (29%). The probability of complications increases with the duration of the disease. If they are life-threatening, the therapy is unequivocally surgical. The conservative treatment of some non-life-threatening complications may be attempted. Surgery is justified only if the complication is life-threatening or a long-lasting active conservative treatment has been proved unsuccessful. The most frequently employed surgical solution is resection of the involved bowel segment(s), recently stricture plasty. Surgical mortality is 4.1%. A characteristic feature of the disease is the frequency of recurrences (28% and 33.3%, respectively). The mortality of the second operation is 18.6%. Prognosis is always uncertain, since recurrences may appear many years after the surgical intervention.