When is surgical intervention indicated in Crohn's disease with obstruction?

• A. Obstruction due to inflammatory edema that responds to corticosteroids.
• B. Obstruction due to fibrotic strictures refractory to medical therapy.
• C. Perianal fistula with abscess.
• D. Short bowel syndrome.

Answer: (B)

Obstruction in Crohn's disease is managed according to what's causing the blockage: active inflammation or fixed scar tissue. When the obstruction is from inflammatory edema, medical therapy such as corticosteroids can reduce the inflammation and often relieve the blockage without surgery. But when the obstruction is caused by fibrotic strictures, the scar tissue narrows the bowel lumen and medical treatments can’t reverse that narrowing. In these cases, surgical intervention is needed to relieve the obstruction, either by removing the narrowed segment or by widening it through strictureplasty, with the goal of preserving as much bowel as possible.

The other scenarios don’t fit as the primary indication for surgery in this context: a perianal fistula with abscess is managed with drainage and fistula care, not bowel obstruction relief; and short bowel syndrome is a consequence of extensive resections and represents a different management issue rather than the immediate indication for addressing an obstructive fibrotic stricture.