Crohn's Disease Surgery - Large Intestinal Resection (Colectomy)

Removal of all or part of the large intestine is less commonly done in Crohn's disease than is a small intestinal resection. It is typically performed when all or part of the colon is affected with Crohn's disease and the symptoms cannot be controlled with medication. Occasionally, the operation is performed because of one or more strictures in the colon or because of a fistula or abscess arising out of the colon.

 

There are a few common segments of colon that may be removed, and each of these operations has its own name describing the part of the colon that has been removed. The right half of the colon in a right hemicolectomy, the left half of the colon in a left hemicolectomy, and the sigmoid colon in a sigmoid resection.

 

 

When a colectomy is performed, it may be partial or complete. In a partial colectomy, only a portion of the large intestine is removed and usually the two cut ends of the intestine are sewn together.

 

 

 

A subtotal colectomy involves removal of all of the large intestine, with the exception of the rectum and perhaps the lower end of the sigmoid colon. In this operation, the last part of the small intestine (ileum) is connected to the rectum to form an ileorectal anastomosis or to the sigmoid colon to form an ileosigmoid anastomosis.

 

 

If the entire colon and rectum are removed, the operation is called a total proctocolectomy. With a total proctocolectomy, the end of the small intestine is usually brought out to the skin as an ileostomy. Patients with known Crohn's disease are usually not candidates for pelvic pouch reconstruction surgery except in special circumstances.