Preoperative optimization of Crohn's disease

Patients with Crohn's disease often present to the surgeon for operative intervention in poor overall condition. They may be taking multiple immunomodulators to attempt to manage their disease, may have significant weight loss and evidence of malnutrition, and 10 to 30% of the time will have intraabdominal sepsis in the form of an abscess or fistula. Preoperative optimization of these patients, when possible, may decrease morbidity and mortality, and may avoid formation of stomas for fecal diversion. Enhancing nutritional status and streamlining immunomodulator therapy prior to surgery may improve outcomes. Medical management of intraabdominal sepsis with percutaneous drainage of abdominal or pelvic abscesses may decrease postoperative septic complications, and may even avert the need for surgical intervention altogether.