Timing of surgery in Crohn’s disease: A key issue in the management

Table 1 Influencing factors in the choice of optimal time to operate on a patient

Severity of symptoms

Type of symptoms

Failure of medical treatment

Adverse effects of medical therapy

Risk of complications due to Crohn’s disease

Established complications

Obvious benefits (or no disadvantages) of surgery

Gastroenterologist

Surgeon

Patient and family

Table 2 Complications of Crohn’s disease and treatment approaches

Complication	Treatment
Acute intestinal obstruction	Conservative
Recurrent intestinal obstruction	Elective surgery
Abdominal abscess	Percutaneous drainage
	Total recovery: medical therapy
	No improvement: urgent surgery
	Improvement: elective surgery
Abdominal fistula	Enteroenteric
	Asymptomatic: conservative
	Symptomatic: elective surgery
	Enterourologic o enterogynecologic
	Elective surgery
	Enterocutaneous
	Improve nutritional status and elective surgery
Free perforation or massive bleeding	Urgent surgery
Severe acute colitis	Medical therapy
	No response in 3-5 d: urgent surgery
	Obvious improvement: medical therapy
Toxic megacolon	Complication of acute colitis: urgent surgery
	Debut: medical therapy
	No response in 1-3 days: urgent surgery
	Response: elective surgery
Perianal disease	Individual treatment and interdisciplinary approach
	Surgery
	Failure medical therapy
	Symptomatic lesions
	Complications