One is when there is a failure of medical management. They either cannot tolerate the medication because they've had an adverse side effect or the medication has not been successful in treating their disease. They have profound symptoms from the disease that affects their quality of life. This is an occasion for surgery.
The second reason a patient may need surgery is that they develop a complication specific to their disease. Complications are unique to the different conditions that fall under inflammatory bowel disease, and these various complications may require emergency surgery. Crohn's disease and ulcerative colitis are each associated with different complications.
What are some of the reasons that people with Crohn's disease in particular might need surgery?
Approximately 50-75% of patients with Crohn's disease may require surgery sometime in their lives. It can be the result of quality of life issues or failure of medication or one of a variety of different complications. Crohn's patients are also at greater risk of cancer of the small bowel.
Complications of Crohn's include toxic megacolon, which is a massive dilatation of the colon that may lead to perforation, bleeding, intestinal or bowel obstruction, abscess formation or fistulization—which are abnormal openings from one loop of bowel to another part of the bowel, to the skin or to another organ of the body.