Small bowel surgery

The terminal ileum is clearly the most frequently involved portion of the intestine in patients with Crohn's disease. However, it is more difficult to discern the relative frequency of isolated small bowel involvement in this population. Stricturing disease is commonly encountered, and we review both the pathophysiology as well as the major techniques of resection and strictureplasty. An algorithm for perforating disease is also presented, as well as strategies for the management of fistulizing disease. As with other portions of the GI tract, multi-disciplinary care is the key to optimal outcomes. However, the surgeon plays a central role in the management of complicated small bowel disease, especially in cases of obstruction, perforation, and fistulization.