[Crohn's disease of the small intestine]

Any symptomatic manifestation of Crohn's disease results not from the disease itself but from some complication. The first complication is stenosis, which precedes and favors the appearance of abscesses, fistulae, perforations and sometimes hemorrhages. The ideal treatment consists in identifying and treating the disease as early as the appearance of stenosis and before the other complications occur. In our series, mortality most often was caused by an infection that was not or poorly managed, even when the primary cause of death was embolism or sometimes a massive hemorrhage. In many patients, the risks of septic complications are all the higher as the subject's immunological defense is weakened by immunodepressive corticosteroid treatments and by malnutrition. All septic foci must therefore be located and drained before any extensive surgical operation. Malnutrition can be improved by parenteral nutrition, and often by enteral feeding as well. After severe surgical complications, the next operation should not be performed until 12 weeks have elapsed, in order to reduce both technical difficulties and risks.