I am a 21-year-old female with Crohn's disease. Medications did not put my disease into remission, so I've had three surgeries. The first was a subtotal colectomy, and an ileostomy was created. The second, about eight months later, was for "takedown" of the ostomy. Six weeks later, my bowel had punctured, so surgery was performed and yet another ostomy created. It is hard to feel good about myself with an ostomy. It has improved my quality of life, but it constantly makes noises and is not easy to hide. I now need surgery to reconstruct the stoma. Is it unreasonable to want to try and hook my bowel back up? I would hate to go through surgery just to end up where I started.

C.

Crohn's disease is a chronic inflammatory disorder of the colon and small intestine characterized by abdominal pain, weight loss and diarrhea, sometimes with bloody stools. The treatment for Crohn's involves mostly anti-inflammatory or immunosuppressive medications to treat the abnormal immune-system activation that goes along with this disease. In most cases, medications are effective in controlling the inflammatory process and getting the disease under control, at least for the short term.

However, most patients with Crohn's will require surgery at some point. The reasons for surgery include severe disease unresponsive to drug therapy, severe bleeding, intestinal obstruction or perforation, and colon cancer. Unlike surgery for ulcerative colitis, surgery for Crohn's does not "cure" the disease process. In fact, there is a high likelihood of a recurrence near the site of the surgery.

Removal of part or all of the colon (colectomy) is a common operation for Crohn's. After colectomy, doctors create an ileostomy, which is an opening in the abdomen that allows the contents of the ileum, or small intestine, to be collected in a bag for disposal. An ileostomy enables the rectum (or remaining colon) to heal properly before surgeons attempt to reattach it to the end of the small intestine. Often, several months of medical therapy are used before reattachment surgery. It sounds like your operation was complicated by a perforation or leak, possibly due to a fistula. Fistulas -- abnormal connections between the bowel and other organs such as the skin, bladder or vagina -- occur as a result of the intense bowel inflammation seen in Crohn's. In the case of a perforation, an ileostomy has to be recreated to allow the remaining bowel to heal and the infection (caused by the spillage of bowel contents into the abdominal cavity) to clear.

At this point, there are several factors to consider before you proceed. First, before any further surgical procedures are undertaken, it must be clear that your Crohn's is under control. Otherwise, there is a high chance of further complications like you had before. The determination of disease control can be made by your gastroenterologist who will likely rely on endoscopic and/or radiologic imaging for this information. Also, you should consult with a surgeon experienced with complicated Crohn's cases to see whether further surgical intervention is likely to be helpful in your case.

Finally, you will need to decide whether you are willing to undergo another surgical procedure. It is true that the prospect of a long-term ileostomy is difficult burden for a young person. However, many people with ostomies are able to lead near-normal lives, and groups such as the United Ostomy Association and the International Ostomy Association can provide support and guidance.