In general, the patient receiving surgery for Crohn's disease (CD) makes an uncomplicated recovery with a speed consistent with the degree of surgical ‘insult' - which in these days of laparoscopic approach and minimalist resection often means very rapidly indeed. However, in the patient who has had repeated surgery and in those where there was profound intra-abdominal sepsis this may not be the case. A prolonged period of ileus is to be expected and patients may well require parenteral nutrition to support them through this time. A curious and incompletely understood form of functional short-bowel syndrome is also seen in these and other patients after CD resection. Despite apparently limited resection and known adequate residual bowel length, with more than 1.5 m of healthy small intestine remaining in continuity, some patients develop a high-output state with many litres of diarrhoea or stomal effluent each day. Fortunately, in most cases this resolves spontaneously, but the process may take months: again these individuals may need parenteral nutrition support (including home parenteral nutrition in some). Nutritional support is needed in a broader range of postoperative patients, however, and it is increasingly recognised that simply providing supplements and encouraging eating will not be enough to restore lean body mass and function unless it is combined with an exercise programme. Analogy with sports training helps both physicians and patients understand this better. The patient who has undergone CD surgery has often been ill for some time beforehand, and the psychological aspects of chronic disease and the changes brought about by surgery - especially the creation of a stoma - may themselves become the most prominent features of the rehabilitative phase. A multidisciplinary approach is clearly justified and should be made available to all post-operative patients as needed.

Keywords:
Complications, Crohn’s disease, Enhanced recovery, Intestinal failure, Nutrition, Surgery
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.