Surgery in Crohn’s Disease: Two Cases from Jamaica

Surgery in Crohn’s Disease

Two operative cases of Crohn’s disease

Historical note

This article presents two operative cases of Crohn’s disease managed at the University Hospital in Jamaica and updates the original surgical discussion with current evidence-based guidance. The case narratives are retained as historical clinical examples, while the management sections have been revised to reflect contemporary multidisciplinary care, including medical therapy, nutritional optimization, interventional radiology, endoscopy, surgery, postoperative monitoring, thromboprophylaxis, and cancer surveillance.

Crohn’s disease and inflammatory bowel disease have historically been reported as relatively uncommon in Jamaica. A review of patients seen at the University Hospital of the West Indies from January 2000 to January 2010 identified 103 patients with inflammatory bowel disease, including 39 with Crohn’s disease, and concluded that inflammatory bowel disease was relatively uncommon in Jamaica during that period (Inflammatory bowel disease in Jamaica).

Introduction

Surgery remains an important component of Crohn’s disease care, but it is no longer considered in isolation from medical, nutritional, endoscopic, radiologic, and postoperative prevention strategies. Modern surgical guidance emphasizes elective rather than emergency surgery when feasible, preoperative optimization, control of sepsis, steroid reduction when possible, bowel conservation, laparoscopic techniques when appropriate, and structured postoperative monitoring (ECCO Surgical Treatment 2024).

Common reasons for surgery include recurrent or irreversible obstruction from strictures, abscess, fistula, free perforation, uncontrolled hemorrhage, dysplasia or cancer, failure of medical therapy, growth failure in children, severe malnutrition, and unacceptable drug-related complications. Acute free perforation, massive hemorrhage, and toxic megacolon remain uncommon but urgent indications for surgical involvement. More commonly, patients require surgery for obstruction, medically refractory disease, abscess, fistula, or complications related to chronic inflammation.

The following two cases illustrate the surgical complications of Crohn’s disease in Jamaica. Their medical treatment reflects the period in which they were managed. Contemporary medical treatment differs substantially, especially because chronic corticosteroid therapy is avoided, 5-aminosalicylates have little role in moderate-to-severe Crohn’s disease, and biologic or advanced therapies are central for many patients with moderate-to-severe or fistulizing disease (ECCO Medical Treatment 2024, AGA Clinical Practice Guideline 2021, ACG guideline update summary 2025).

Case I

Four years before presentation to hospital, a twenty-year-old man presented to a gastroenterologist with abdominal pains. He was investigated and diagnosed as having Crohn’s disease, for which he was maintained on sulfasalazine and prednisone. This regimen is retained here as historical case detail. In current practice, 5-aminosalicylates are generally not recommended for induction or maintenance of moderate-to-severe Crohn’s disease, and systemic corticosteroids are used for induction rather than maintenance because of toxicity and lack of maintenance benefit (ECCO Medical Treatment 2024, AGA Clinical Practice Guideline 2021).

He was admitted to the Kingston Public Hospital with subacute intestinal obstruction. Azathioprine was added to his drug regimen, and he received blood transfusions for anemia. There was improvement on conservative management, but later he began vomiting intermittently and his stools became diarrheal. Although he became edematous, he lost 30 pounds of body weight over the next three months.

Barium enema examination showed a stricture in the ascending colon. At colonoscopy, cobblestoned mucosa with ulceration was seen in the ascending colon distal to the stricture. Biopsies of this mucosa detected stromal fibrosis only.

During this admission, the patient developed right axillary vein thrombosis, right calf deep vein thrombosis, and pulmonary embolism. Anticoagulation was begun. He was then transferred to the Tropical Metabolic Research Unit for nutritional support. He became febrile and tachypneic, with diminished breath sounds over the left side of the chest. His arterial blood gas values were PO2 50 mmHg, PCO2 28 mmHg, and pH 7.49. Chest x-ray showed a left pleural effusion, and lung scan showed segmental perfusion defects consistent with pulmonary embolism. He was then transferred to the medical floor of the University Hospital, where colicky pains and vomiting predominated.

On physical examination, the patient was emaciated and distressed by pain. His mucous membranes were pale. He had finger clubbing and dependent edema. He weighed 110 pounds. His skin was dry and shiny, with variable pigmentation and flaky squames. His tongue had no filiform papillae, and his hair was sparse. His radial pulse rate was 120/min, blood pressure was 120/80 mmHg, and heart sounds were normal. Over the posterior chest, the percussion note was diminished, and there were crackles over both bases. His abdomen was distended, tympanitic, and tender over a right lower abdominal mass. Bowel sounds were hyperactive. His perianal skin was erythematous, and he had an anterior anal skin tag.

His hemoglobin concentration was 8.2 g/dL, and white blood cell count was 4.3 x 10^9/L. Serum urea, electrolytes, and creatinine were normal. Results of other blood investigations were:

Test	Result	Unit
PT	26/14	sec
PTT	53/31	sec
Calcium	1.9	mmol/L
Total bilirubin	5	micromol/L
Alkaline phosphatase	243	IU/L
SGOT	14	IU/L
GGT	314	IU/L
Total protein	43	g/L
Albumin	15	g/L
Globulin	28	g/L

His intestinal obstruction resolved on medical management, and elective surgery was planned to follow his course of anticoagulation. Two weeks later, intestinal obstruction recurred. Conservative management was again undertaken, but after three days of unremitting obstruction, emergency surgery was performed. Heparin was discontinued six hours before surgery. Preoperative PT and PTT were normal. Prophylactic antibiotics, heparin, and hydrocortisone were given.

At operation, the bowel was dilated proximal to a stricture in the ascending colon. The ileocolic segment was inflamed, and creeping fat was noted on the distal ileum. Mesenteric lymph nodes were enlarged. A right hemicolectomy and ileotransverse anastomosis were performed.

Parenteral nutritional support was begun on the first postoperative day. On postoperative day two, the patient passed flatus, and oral fluids, prednisone, and sulfasalazine were started. Warfarin anticoagulation was commenced on day seven. Parenteral nutritional supplementation was given for 10 days. On day twelve, the patient was discharged home on a supplemented diet, prednisone, and sulfasalazine.

The excised ileocolic segment showed a fibrous stricture in the ascending colon. The intestinal wall was thickened and inflamed, and the mucosa had extensive ulceration and a cobblestoned appearance. The resection margins were grossly involved. Histological examination showed mucosal ulceration and fissures, some extending into the submucosa. There was lymphoid hyperplasia, lymphangiectasia, hyperplasia of the muscularis mucosa, fibrosis, and ill-defined granulomas composed of epithelioid and multinucleated giant cells. There was accompanying glandular distortion without atrophy. The resection margins were involved to a lesser extent. Lymph nodes showed sinus edema and congestion but no granulomas.

Case II

Three years before attending the University Hospital, a twenty-nine-year-old man was admitted to another institution with right iliac fossa pain and tenderness. After appendectomy, he was diagnosed as having Crohn’s disease. He suffered recurrent abdominal pains and diarrhea. He presented to the University Hospital with an exacerbation of abdominal pains and diarrhea. On admission, he was found to be anemic and to have an abdominal mass. Abdominal ultrasonography demonstrated a small bowel mass in the right iliac fossa. Subacute intestinal obstruction resolved on conservative management. He was discharged home on acetylsalicylate and prednisolone.

Three weeks later, he was readmitted to hospital with recurrence of abdominal cramps and distension. He began vomiting, and his pain became constant. He then became febrile. On physical examination, he was dehydrated and had generalized peritonitis.

Investigations showed hemoglobin concentration 12.7 g/dL and white blood cell count 39.2 x 10^9/L. Urea and electrolytes were normal. Chest x-ray showed extensive pneumoperitoneum.

The patient was resuscitated and given antibiotics. The findings at emergency laparotomy included a perforation of the distal jejunum and multiple small bowel strictures proximal and distal to the perforation. The distal bowel was matted and inflamed. Subphrenic, interloop, and pericolic abscesses were found. The abscesses were drained, and the grossly affected bowel was resected and primarily anastomosed. The skin incision was left open to heal by secondary intention.

Recovery was uneventful. The patient began oral intake on the fourth postoperative day and was discharged home on the tenth postoperative day. Histopathological examination of the resected specimen confirmed Crohn’s disease and showed microscopic involvement of the resection margins.

Discussion

These two cases demonstrate several major surgical themes in Crohn’s disease: diagnostic difficulty, malnutrition, stricturing disease, recurrent obstruction, venous thromboembolism, perforation, abscess, steroid exposure, and the need to balance bowel conservation with sepsis control and safe reconstruction.

Difficulty with biopsy diagnosis of Crohn’s disease is well recognized because mucosal biopsies may be nonspecific, especially when inflammation is patchy or deeper layers are involved. Clinical, endoscopic, radiographic, operative, and histologic features are often considered together. Cross-sectional imaging, colonoscopy with ileoscopy, biopsies, and, when needed, magnetic resonance enterography, computed tomography enterography, intestinal ultrasound, or pelvic MRI for perianal disease now play important roles in assessment and monitoring (ACG guideline update summary 2025).

Both patients were malnourished and had recurrent obstructive symptoms before surgery. In current practice, these features would prompt early multidisciplinary review by gastroenterology, colorectal surgery, nutrition, radiology, and, where relevant, anesthesia and hematology. ECCO recommends preoperative optimization followed by reassessment and favors elective bowel resection over emergency surgery when feasible because emergency surgery is associated with higher morbidity, higher stoma rates, and worse perioperative outcomes (ECCO Surgical Treatment 2024).

Case I also illustrates the thrombotic risk associated with inflammatory bowel disease. International consensus guidance states that IBD is associated with approximately a twofold increased risk of venous thromboembolism and that active disease, hospitalization, and surgery further increase this risk. Thromboprophylaxis should be given to hospitalized patients with IBD unless contraindicated, and extended prophylaxis after discharge should be considered for patients with strong risk factors (International consensus on thrombotic events in IBD). ECCO surgical guidance also recommends extended postoperative thromboembolism prophylaxis after Crohn’s disease surgery in appropriate patients (ECCO Surgical Treatment 2024).

Case II illustrates free perforation, a rare but life-threatening complication. Contemporary management requires prompt resuscitation, broad-spectrum antibiotics, source control, and early surgical decision-making. Primary anastomosis versus temporary stoma should be individualized according to hemodynamic stability, contamination, nutrition, steroid exposure, sepsis, tissue quality, and the feasibility of safe reconstruction (ECCO Surgical Treatment 2024).

When to operate

The decision to operate in Crohn’s disease should be individualized and made jointly by the patient, gastroenterologist, and surgeon. Indications include recurrent or irreversible obstruction, symptomatic strictures, medically refractory disease, penetrating disease with abscess or fistula, perforation, uncontrolled bleeding, toxic megacolon, dysplasia or cancer, severe malnutrition, growth failure, or unacceptable complications of medical therapy.

Elective surgery is preferred over emergency surgery when possible. ECCO recommends preoperative optimization and reassessment before surgery and notes that elective surgery is preferable in obstructive and fistulizing Crohn’s disease when clinical circumstances allow (ECCO Surgical Treatment 2024).

Not every stricture requires immediate resection. Selected short small-bowel strictures, particularly those less than 5 cm, may be treated with endoscopic balloon dilation when anatomy and expertise are suitable. Limited terminal ileal or ileocecal disease may be managed with optimized medical therapy, biologic therapy, endoscopic intervention, strictureplasty, or laparoscopic resection depending on disease phenotype, patient priorities, and local expertise (ECCO Surgical Treatment 2024).

Principles of surgery for Crohn’s disease

Surgery for Crohn’s disease is guided by several current principles:

• Crohn’s disease is chronic and may involve any part of the gastrointestinal tract.
• Surgery treats complications and refractory disease but does not cure Crohn’s disease.
• Surgery should be performed after optimization whenever feasible.
• Bowel conservation is important because recurrent disease and repeat surgery can lead to short bowel syndrome.
• Sepsis should be controlled before definitive reconstruction whenever possible.
• Steroid exposure should be reduced before elective surgery when feasible.
• Laparoscopic surgery is preferred when expertise and anatomy allow.
• Strictureplasty is an important bowel-sparing option for selected small-bowel strictures.
• Postoperative recurrence monitoring and prevention are essential.

Postoperative recurrence is common and should be described by type. Endoscopic recurrence often precedes symptoms, and clinical recurrence may occur later. Recent reviews report high rates of endoscopic lesions after ileocolonic resection, and current guidelines recommend ileocolonoscopy within 6 to 12 months after surgery (Management of Postoperative Recurrence 2023, ECCO Surgical Treatment 2024).

Preparation for surgery

Preoperative optimization is central to modern Crohn’s surgery. This includes assessment and treatment of malnutrition, anemia, fluid and electrolyte abnormalities, sepsis, abscess, steroid exposure, venous thromboembolism risk, and smoking. ECCO recommends preoperative nutritional assessment and identification of nutritional risk by IBD-dedicated dietitians. Enteral nutrition is preferred when feasible, while parenteral nutrition is reserved for patients who cannot tolerate or meet needs by enteral nutrition (ECCO Surgical Treatment 2024).

Steroids should be tapered whenever possible before elective surgery because prolonged or high-dose systemic corticosteroids increase postoperative complications. Patients with possible adrenal suppression may still require perioperative steroid coverage, but this should not obscure the goal of minimizing chronic steroid exposure before planned surgery (ECCO Surgical Treatment 2024).

Biologic therapy is now part of standard care for many patients with moderate-to-severe Crohn’s disease. ECCO surgical guidance recommends against routine cessation of biologics before surgery because available evidence does not support automatic discontinuation solely to reduce postoperative complications (ECCO Surgical Treatment 2024).

Gastric and duodenal disease

Gastroduodenal Crohn’s disease is uncommon and should be managed according to symptoms, inflammatory activity, stricture anatomy, nutritional status, and malignancy concern. Obstructive symptoms may be approached with medical therapy when inflammation predominates, endoscopic dilation in selected short accessible strictures, or surgery for refractory obstruction. Surgical options may include bypass, stricturoplasty, or resection in selected cases, ideally in centers with relevant expertise.

Ileal and ileocolic disease

Crohn’s disease commonly involves the distal ileum or ileocecal region, and surgery is often required for stricturing or penetrating complications. Obstruction should initially be assessed for inflammatory, fibrotic, or mixed features because treatment differs. Inflammatory strictures may respond to medical therapy, while predominantly fibrotic strictures often require endoscopic or surgical intervention.

For selected short strictures, endoscopic balloon dilation is an option. For small-bowel Crohn’s disease, strictureplasty preserves bowel length and is recommended by ECCO as an alternative to resection in appropriate cases. For limited terminal ileal or ileocecal disease, laparoscopic ileocecal resection is a reasonable option and may be considered alongside biologic therapy after shared decision-making (ECCO Surgical Treatment 2024).

Resection should remove the segment responsible for symptoms or complications while conserving bowel. Extensive resection to obtain wide microscopic clearance is generally avoided because Crohn’s disease may recur and because bowel preservation is a major goal. When disease is extensive or skip lesions are present, the operative plan should focus on the segment causing obstruction, sepsis, bleeding, or other major complications.

Strictureplasty

Strictureplasty is a bowel-sparing operation for selected small-bowel Crohn’s strictures, especially when there are multiple strictures, prior resections, or concern for short bowel syndrome. ECCO recommends strictureplasty as an alternative to resection in small-bowel Crohn’s disease and reports recurrence rates in the range of 3 percent to 25 percent in the guideline summary extracted for this review (ECCO Surgical Treatment 2024).

Strictureplasty is generally avoided when there is uncontrolled sepsis, free perforation, adjacent abscess or phlegmon, suspected malignancy, poor tissue quality, or an unsuitable stricture pattern. Patient condition matters: malnutrition, high-dose steroids, active sepsis, and severe systemic illness should prompt optimization or staged surgery whenever possible.

Colonic disease

Surgery for colonic Crohn’s disease should be individualized according to disease extent, rectal and perianal involvement, continence, dysplasia or cancer risk, nutritional status, sepsis, medication history, and patient preference. Options include segmental colectomy, subtotal colectomy with ileorectal anastomosis, total proctocolectomy with end ileostomy, or staged approaches in high-risk settings.

Extensive colitis with severe rectal or perianal involvement may require proctocolectomy or diversion in selected cases. When rectal involvement is minimal and continence is good, ileorectal anastomosis may be considered, but ongoing surveillance and recurrence risk must be discussed. Contemporary decisions should be made in multidisciplinary IBD settings whenever available (ECCO Surgical Treatment 2024).

Intra-abdominal abscesses

Intra-abdominal abscess in Crohn’s disease requires prompt sepsis control. ECCO recommends control of sepsis before abdominal surgery and suggests intravenous antibiotics plus percutaneous image-guided drainage as first-line treatment when feasible. After successful drainage, selected patients may be managed conservatively, but surgery is required for refractory abscess, associated stenosis, enterocutaneous fistula, persistent sepsis, or failure of nonoperative management (ECCO Surgical Treatment 2024).

When surgery is needed after abscess drainage, interval surgery after optimization may reduce complications and stoma formation. Primary anastomosis may be appropriate in selected optimized patients, but diversion or staged surgery should be considered when sepsis, steroids, malnutrition, contamination, or poor tissue quality make anastomosis unsafe.

Enteroenteric and internal fistulae

Internal fistulae occur in penetrating Crohn’s disease and may connect bowel to bowel, bladder, vagina, skin, or other organs. Management depends on symptoms, anatomy, associated abscess, obstruction, nutritional status, and inflammatory activity. Asymptomatic or minimally symptomatic enteroenteric fistulae may not require immediate surgery, while symptomatic fistulae, bacterial overgrowth, abscess, obstruction, recurrent infection, or failure of medical therapy often require intervention.

Modern management is multidisciplinary. Imaging defines anatomy and abscesses. Sepsis is drained. Nutrition is optimized. Medical therapy, including biologic or advanced therapy, is used for active inflammatory disease when appropriate. Surgery is reserved for complications, refractory disease, or fistulae unlikely to close with medical management alone (ECCO Medical Treatment 2024, ECCO Surgical Treatment 2024).

Rectovaginal and anogenital fistulae

Rectovaginal and anogenital fistulae are complex manifestations of Crohn’s disease and require careful evaluation of rectal inflammation, sphincter function, abscess, anatomy, and patient priorities. Pelvic MRI and examination under anesthesia are often used to define anatomy and drain sepsis.

ECCO suggests medical treatment for anogenital and rectogenital fistulae and counseling for surgical closure in selected patients. Diversion or proctectomy may be required for refractory complex disease, severe rectal involvement, or uncontrolled sepsis (ECCO Surgical Treatment 2024).

Enterovesical fistulae

Enterovesical fistulae usually require evaluation with cross-sectional imaging, endoscopy as indicated, urine studies, and surgical planning with attention to abscess, ureteric involvement, bladder involvement, and malignancy exclusion when relevant. Treatment commonly includes resection of the diseased bowel segment, closure or management of the bladder defect, and bowel reconstruction. Diversion or staged reconstruction may be safer when the patient has active sepsis, malnutrition, high-dose steroids, or poor tissue quality.

Enterocutaneous fistulae

Enterocutaneous fistulae may occur spontaneously in penetrating Crohn’s disease or after surgery, drainage, or anastomotic leak. Management begins with sepsis control, imaging, wound and skin protection, fluid and electrolyte correction, and nutritional optimization. Enteral nutrition is preferred when feasible, but parenteral nutrition may be required when enteral intake is not possible or does not meet nutritional needs (ECCO Surgical Treatment 2024).

Definitive surgery is usually delayed until sepsis is controlled and the patient is nutritionally and medically optimized. Operation may include resection of active Crohn’s disease, fistula tract management, reconstruction, or diversion depending on anatomy and risk.

Anorectal and perianal disease

Perianal Crohn’s disease requires distinction between simple and complex fistulae, assessment for rectal inflammation, and prompt drainage of abscesses. The older statement that perianal disease occurs in more than 90 percent of Crohn’s patients should not be generalized to all Crohn’s disease. Current pathways describe perianal manifestations as fistulae, abscesses, ulcers, fissures, and strictures, and perianal fistulizing Crohn’s disease is typically discussed as a distinct phenotype (Crohn’s and Colitis Canada perianal pathway 2024).

For active perianal fistula, AGA recommends infliximab for induction and maintenance of fistula remission and suggests adalimumab, ustekinumab, or vedolizumab over no treatment. AGA recommends against antibiotics alone for active perianal fistula without abscess and recommends biologic therapy plus an antibiotic over biologic therapy alone for induction in appropriate patients (AGA Clinical Practice Guideline 2021).

Surgery and medical therapy should be coordinated. ECCO recommends fistulotomy only for selected simple fistulae without proctitis, seton placement before medical or surgical therapy when indicated, avoidance of chronic seton as sole therapy except palliation, and combined medical-surgical closure for selected complex fistulae (ECCO Surgical Treatment 2024). ASCRS guidance similarly frames Crohn-related anorectal fistula management as a combination of medical and surgical approaches (ASCRS guideline summary 2022).

Free perforation

Free perforation in Crohn’s disease is rare but life-threatening. Management requires resuscitation, antibiotics, source control, and urgent surgical assessment. Resection of the perforated segment is usually required. Primary anastomosis may be appropriate in selected stable, optimized patients with limited contamination and acceptable tissue quality. Temporary stoma or staged surgery is safer when there is diffuse contamination, shock, high-dose steroids, severe malnutrition, poor tissue quality, or uncontrolled sepsis (ECCO Surgical Treatment 2024).

Massive hemorrhage

Massive hemorrhage from Crohn’s disease is uncommon. Management includes resuscitation, localization of bleeding when feasible, correction of coagulopathy, endoscopic or interventional radiologic therapy when appropriate, and surgery when bleeding is ongoing or life-threatening. Segmental small-bowel bleeding may be treated with resection and anastomosis if safe. Severe colonic bleeding may require colectomy or staged surgery depending on disease extent, hemodynamic stability, and contamination.

Toxic megacolon and fulminant colitis

Toxic megacolon and fulminant colitis are surgical emergencies when medical therapy fails or complications develop. Initial management includes resuscitation, bowel rest, correction of electrolytes, broad-spectrum antibiotics when infection or perforation is a concern, venous thromboembolism prophylaxis unless contraindicated, and urgent gastroenterology and colorectal surgery involvement. Perforation, uncontrolled bleeding, worsening toxicity, or failure of appropriate medical rescue therapy should prompt urgent colectomy or other source-control surgery. If this section is used for clinical guidance, it should also be cross-checked against current acute severe colitis and toxic megacolon guidelines.

Complications of surgery and postoperative recurrence

Postoperative complications include wound infection, intra-abdominal abscess, anastomotic leak, ileus, venous thromboembolism, hernia, short bowel syndrome, stoma complications, and recurrent Crohn’s disease. Patients undergoing proctectomy may develop delayed perineal wound healing or chronic perineal sinus, particularly when there is active perianal sepsis, malnutrition, or ongoing inflammation.

Crohn’s disease recurrence after intestinal resection is common. Endoscopic recurrence often precedes symptoms, and therefore symptom-based follow-up alone is inadequate. Current evidence reviews report high rates of endoscopic recurrence after ileocolonic resection, and guidelines recommend ileocolonoscopy within 6 to 12 months after surgery to assess for recurrence and guide treatment escalation (Management of Postoperative Recurrence 2023, ECCO Surgical Treatment 2024).

Risk factors for postoperative recurrence include smoking, penetrating or perforating disease, prior resection, perianal disease, granulomas, and other high-risk features. ECCO suggests postoperative prophylactic medical therapy for high-risk patients and identifies anti-TNF therapy as among the most effective options, with other therapies considered according to patient risk, prior drug exposure, and local practice (ECCO Surgical Treatment 2024, Management of Postoperative Recurrence 2023).

Colorectal cancer surveillance

Longstanding Crohn’s colitis increases colorectal cancer risk, particularly with extensive colonic involvement, persistent inflammation, primary sclerosing cholangitis, prior dysplasia, strictures, post-inflammatory polyps, or family history. ECCO surveillance guidance recommends screening colonoscopy 6 to 8 years after symptom onset in patients with Crohn’s disease with colonic involvement, followed by risk-stratified surveillance intervals (ECCO colorectal carcinoma surveillance).

Conclusion

The two Jamaica cases illustrate the severe complications that can occur in Crohn’s disease, including malnutrition, recurrent obstruction, venous thromboembolism, perforation, abscess, and the need for emergency or urgent surgery. In contemporary practice, surgery is integrated into multidisciplinary IBD care and is ideally performed electively after optimization whenever feasible.

Appropriately selected surgery can relieve obstruction, control sepsis, treat fistulizing or perforating disease, and improve quality of life. However, surgery does not cure Crohn’s disease. Postoperative recurrence monitoring, risk-factor modification, smoking cessation, steroid minimization, nutritional care, venous thromboembolism prevention, and individualized medical prophylaxis are essential parts of modern care.

Educational disclaimer

This article is for educational purposes and does not substitute for individualized medical advice. Patients with Crohn’s disease should be managed by qualified clinicians familiar with their clinical history, disease phenotype, medication exposure, nutritional status, and surgical risk.

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