Abdominal pain, diarrhea, bloody excrement, etc. 'Inflammatory bowel disease', when should the surgery be performed?
Aug 08, 2024
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Inflammatory bowel disease is largely divided into Crohn's disease and ulcerative colitis, which must be managed by lifelong drug treatment. To make matters worse, if the drug is no longer effective, symptoms become severe and complications arise, surgery should be considered.
According to the Health Insurance Review and Assessment Service's data on the health care big data opening system (disease code: K50 Crohn's disease, K51 ulcerative colitis), the number of patients with inflammatory bowel disease surged by more than 30% in the five years from 2019 (78,814) to 2023 (92,665). It usually develops in young age, and it is an incurable disease that follows throughout life. As of 2023, 57% of all patients are in their 20s and 40s.
The cause of inflammatory bowel disease is not yet clearly known. However, it is believed that various factors such as heredity, personal immune response, composition of intestinal microorganisms, and environmental factors work in combination. Recently, it is speculated that westernized eating habits and the generalization of spicy, salty, and greasy foods have a great influence.
The most basic test is colonoscopy, and it is diagnosed by combining the patient's symptoms, blood and biopsy, and radiology findings.
The principle of treatment is medication, which aims to maintain symptom relief and remission (when symptoms are stable). However, symptoms may worsen or various complications may occur because the drug no longer works during drug treatment. In this case, surgery can be considered.
As a complication of Crohn's disease, intestinal obstruction may occur due to narrowing of the intestine. Surgery is also necessary if the intestines are perforated and abscesses (a phenomenon in which cells die of inflammation and pus is accumulated) or fistula (a tubular passage in tissues) occur in the abdominal cavity. In particular, if the disease persists for a long time, the likelihood of colon cancer increases. If cancer is suspected, surgery is also considered.
The surgery is performed to cut off the inflamed part, and even if the intestines are partially resected by surgery, Crohn's disease is likely to recur in the remaining intestines, so the resection surgery is performed only when necessary. Continuous medication is important even after surgery.
Ulcerative colitis may also require surgery if there is a limit to medical treatment, if sudden massive bleeding does not stop, if colon perforation occurs, fulminant colitis (a sudden occurrence of very severe ulcerative colitis), or if colon cancer occurs.
Ulcerative colitis surgery is mainly performed with a total colon resection that resects both colon and rectum. The lesion area is excised and the end of the small intestine is transformed into a J shape and connected to the anal canal. This form helps to store feces. In order to protect the anastomosis, the temporary small intestine is usually kept in the abdominal wall for two to three months, and after that, if there is no complication of the anastomosis, the temporary small intestine is safely restored into the abdominal cavity.
Hong Gwang-dae, a professor of colorectal surgery at Korea University Ansan Hospital, said, `Some patients who need surgery sometimes try to postpone the surgery as much as possible due to vague fear, but if the symptoms worsen and they undergo emergency surgery, not only the scope of surgery expands, but also the worst situation occurs in which laparotomy should be considered"The most important thing in treatment is that the patient undergoes surgery at the right time."
In addition, Professor Hong "Recently, some hospitals have a multidisciplinary collaborative system for inflammatory bowel disease"A number of specialists, including gastroenterology, colorectal surgery, radiology, and pediatrics, are gathered together to share the condition of patients with high difficulty in treatment and regular discussions are being held to derive the optimal timing of surgery, if necessary, from the establishment of a customized treatment plan for each patient."," he added.
Since inflammatory bowel disease is a chronic intractable disease with no clear cause, it is important to be accurately diagnosed early and to maintain remission through constant treatment and improvement of lifestyle habits such as smoking cessation and abstaining from alcohol. Maintaining a balanced diet is also an important factor in treatment, as Western-style eating habits are being pointed out as the cause of the outbreak.
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