Question

29-year-old man with Crohn's disease with recurrent episodes of colicky abdominal pain, distension and vomiting. After initial decompression and resuscitation, imaging shows a localized fixed stricture with proximally dilated bowel loops. Obstructive symptoms persist despite medical management. Colon and rectum uninvolved. Best management?

• A. Right hemicolectomy
• B. Total proctocolectomy with end ileostomy
• C. Limited resection of the involved segment with primary anastomosis
• D. Restorative proctocolectomy with ileal pouch

Hint:

Crohn's disease recurs, so remove only the diseased stricture and save bowel length.

Answer 1

The Correct Option is C

Step 1: Sort the case into a surgical category:
This is a small bowel obstruction from Crohn's disease. It is not a colitis problem, because the colon and rectum are normal.
Crohn's disease is a lifelong condition that can come back anywhere in the gut after surgery. So the operation should only deal with the part causing the complication.

Step 2: Match the extent of disease to the extent of surgery:
The disease causing trouble is one short, fixed segment. The surgeon should take that segment and nothing more.
Going wider would not lower the risk of recurrence. It would only raise the chance of short bowel syndrome later in a young patient.
This gives us a simple rule: localized problem, limited resection.

Step 3: Go through the options with this rule:
Right hemicolectomy: removes the colon, which is healthy. Too much, so not chosen.
Total proctocolectomy with end ileostomy: removes the whole large bowel and rectum and gives a permanent stoma. Not justified when they are normal.
Restorative proctocolectomy with ileal pouch: a colitis operation used in ulcerative colitis and familial polyposis. In Crohn's disease the pouch tends to fail. Not chosen.
Limited resection with primary anastomosis: removes only the stricture, restores continuity and saves length. This fits.

Step 4: Why resection margins and bowel length matter:
Many Crohn's patients need more than one operation in their life. If each operation removes a long length of gut, the patient may end up with short bowel syndrome and need parenteral nutrition.
Studies show that removing only the grossly diseased bowel gives the same recurrence rate as removing wide margins. So the surgeon keeps the margins short.

Step 5: Add the role of stricturoplasty:
A stricturoplasty can also be done, especially for multiple short strictures. It is not listed in the options, so the answer is the resection of the involved segment.

Final Answer:
The best management is limited resection of the involved segment with primary anastomosis. This is option (3). \[ \boxed{\text{Option (3)}} \]