Abstract:
Crohn’s disease in the small bowel could present itself as an inflammatory stricture,
a fibrotic stricture as penetrating disease or a combination of both. It is pertinent
to differentiate the disease process as well as its extent to effectively manage the
disease. Currently, a combination of medical and surgical therapies forms part of the
treatment plan while the debate of which therapy is better continues. In managing the
strictures, identification of the disease process through imaging plays a pivotal role as
inflammatory strictures respond to anti-tumor necrosis factor (TNF) and biological agents,
while fibrotic strictures require endoscopic or surgical intervention. Recent evidence
suggests a larger role for surgical excision, particularly in ileocolic disease, while achieving
a balance between disease clearance and bowel preservation. Several adaptations
to the surgical technique, such as wide mesenteric excision, side to side or Kono-S
anastomosis, and long-term metronidazole therapy, are being undertaken even though
their absolute benefit is yet to be determined. Penetrating disease requires a broader
multidisciplinary approach with a particular focus on nutrition, skincare, and intestinal
failure management. The current guidance directs toward early surgical intervention for
penetrating disease when feasible. Accurate preoperative imaging,medicalmanagement
of active diseases, and surgical decision-making based on experience and evidence play
a key role in success.
