A 45-year-old woman with Crohn's disease of the terminal ileum is found to have a 3 cm stricture causing recurrent subacute obstruction. Medical therapy has been optimised. Which minimally invasive surgical option is MOST appropriate?

• A Right hemicolectomy with wide resection margins
• B Endoscopic balloon dilation — avoided in Crohn's due to fistula risk
• C Formation of permanent ileostomy to rest the bowel
• D Strictureplasty (Heineke-Mikulicz type) to preserve bowel length ✓

Explanation

For short Crohn's strictures (<10 cm), particularly in the small bowel where preservation of length is critical (to prevent short bowel syndrome), strictureplasty is the preferred surgical option. Heineke-Mikulicz strictureplasty (longitudinal incision, transverse closure) widens the stricture without resecting bowel. Recurrence rates are comparable to resection. Endoscopic balloon dilation is actually valid for short fibrous strictures (<5 cm) but is not 'avoided' — it is a reasonable first-line endoscopic approach. For this surgical question context, strictureplasty is the optimal answer.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.