A 45-year-old man with known Crohn's disease presents with recurrent small bowel obstruction. CT shows a 15 cm stricture in the terminal ileum with prestenotic dilation. He has had two prior ileocaecal resections and his remaining small bowel is estimated at 180 cm. What is the preferred management to preserve bowel length?

• A Segmental resection of the strictured segment
• B Balloon dilation via enteroscopy
• C Long-term nutritional support and steroid therapy
• D Strictureplasty (Heineke-Mikulicz or Finney technique) ✓

Explanation

In Crohn's disease with recurrent fibrostenotic strictures and limited small bowel reserve, strictureplasty preserves bowel length while relieving obstruction. For strictures up to 10 cm, Heineke-Mikulicz strictureplasty is used; for 10-25 cm strictures, Finney strictureplasty is preferred; and for longer strictures, the Michelassi isoperistaltic side-to-side strictureplasty is applicable. Given this patient's prior resections and 180 cm of remaining small bowel, further resection risks short bowel syndrome, making strictureplasty the preferred option.

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

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Written and medically reviewed by the StethoPrep medical team.