Acute presentations of Crohn disease in adults

De Simone, 2021

Patients with Crohn disease can present with acute complications in addition to flares of their disease—these complications require prompt recognition and appropriate care. The most common acute complications of Crohn disease are bowel obstruction, bowel perforation, nephrolithiasis and cholelithiasis.

Patients with a bowel obstruction often present with nausea, vomiting and abdominal distension in the absence of bowel motions or flatusAdamina, 2020. In patients with Crohn disease, it is usually caused by intestinal strictures; however, it may also be caused by adhesions, particularly in patients who have had prior abdominal surgery. Bowel obstruction should be managed collaboratively between surgeons and gastroenterologists. Decompression of the bowel with a nasogastric tube is often required. If the obstruction is due to an inflammatory stricture, this may respond to intravenous corticosteroid treatment. Patients with purely fibrostenotic disease or symptoms caused by adhesions do not respond to intravenous corticosteroids and often require exploratory surgery with resection or lysis of adhesions.

In patients with Crohn disease, bowel perforation may occur in segments with deep ulceration, or upstream from strictures. Bowel perforations that are contained can be managed conservatively with antibiotic treatment, drainage of any abscesses larger than 3 cm, and dietary measures. Bowel perforations that are uncontained require surgical exploration and usually the creation of a temporary diverting stoma.

Patients with ileal Crohn disease, particularly those who have had prior resection, are also at higher risk of developing nephrolithiasis and cholelithiasisMalik, 2022.