Crohn's Disease Surgery: Ileocolonic Resection with Mucous Fistula

For severe, refractory Crohn's disease limited to the ileocolonic region, an ileocolonic resection with end ileostomy and mucous fistula (Hartmann's procedure variant) may be performed.

Procedure

• Resection of diseased terminal ileum and cecum/ascending colon
• Proximal ileum brought out as end ileostomy (functional stoma)
• Distal colonic stump closed and brought to skin as mucous fistula (drains mucus, allows future reanastomosis)

Indications

• Failed medical therapy (biologics, immunomodulators)
• Strictures, fistulas, abscesses, perforation, cancer risk
• Severe malnutrition or growth failure in adolescents

Considerations

• Not a "transplant"; no donor organ. "Transplant" in query likely refers to surgical reconstruction
• Stoma care education critical
• Reanastomosis possible after recovery (3–6 months) if disease quiescent
• Recurrence at anastomosis common (~30% at 3 years); postoperative biologics reduce risk

This is a major surgery reserved for severe cases. Multidisciplinary IBD team decision-making is standard.