Timing of surgery in Crohn’s disease: A key issue in the management

Table 2 Complications of Crohn’s disease and treatment approaches

Complication	Treatment
Acute intestinal obstruction	Conservative
Recurrent intestinal obstruction	Elective surgery
Abdominal abscess	Percutaneous drainage
	Total recovery: medical therapy
	No improvement: urgent surgery
	Improvement: elective surgery
Abdominal fistula	Enteroenteric
	Asymptomatic: conservative
	Symptomatic: elective surgery
	Enterourologic o enterogynecologic
	Elective surgery
	Enterocutaneous
	Improve nutritional status and elective surgery
Free perforation or massive bleeding	Urgent surgery
Severe acute colitis	Medical therapy
	No response in 3-5 d: urgent surgery
	Obvious improvement: medical therapy
Toxic megacolon	Complication of acute colitis: urgent surgery
	Debut: medical therapy
	No response in 1-3 days: urgent surgery
	Response: elective surgery
Perianal disease	Individual treatment and interdisciplinary approach
	Surgery
	Failure medical therapy
	Symptomatic lesions
	Complications