Common causes of surgical bowel obstruction in IBD

What is known

• Obstruction and sepsis are the two most common indications for surgery in jejunal/ileal crohn's; hemorrhage and carcinoma are much less common. ¹
• Up to a fifth of crohn's patients present with worsening obstipation, most often from terminal ileal stricturing +/- ileocecal valve, or multifocal small-bowel strictures. ¹
• Multiple tight strictures transform bowel into dilated saccular segments separated by ring-like strictures, driving high-grade obstruction. ¹
• Less common causes include enterolithiasis forming proximal to a fixed ileal stricture and adhesive obstruction. ²

What is unknown / caveats

• Evidence is descriptive/narrative, not epidemiologic frequency data
• Excerpts are crohn's-focused; ulcerative colitis obstruction is not characterized
• Acute inflammatory (potentially reversible) obstruction versus fibrotic (fixed) stricture distinguishes who may settle medically from who needs surgery, and the excerpts note no hard threshold for operating ³.

References

1. Strong SA. Surgical treatment of inflammatory bowel disease. Curr Opin Gastroenterol. 2002;18(4):441-6. PMID: 17033319.

2. Bruni R, Chirco L, Lemeni AR, Petrocca S. Intermittent small bowel obstruction by jejunal enteroliths in a patient with a Crohn's disease stricture. Chir Ital. 2002;54(6):903-5. PMID: 12613344.

3. [No authors listed]. Obstruction in Crohn's Disease: Strictureplasty Versus Resection. Curr Treat Options Gastroenterol. 2000;3(3):191-202. PMID: 11097736.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.