Patients who demonstrate signs of fulminant colitis, peritonitis, or complications such of obstruction, significant gastrointestinal hemorrhage, severe dehydration, or fluid/electrolyte imbalance should be hospitalized under the care of a gastroenterologist or surgeon. Hospital admission should be considered in less severe cases that fail outpatient management. Surgical intervention is indicated in those patients with complications of the disease, including intestinal obstruction or hemorrhage, perforation, abscess or fistula formation, toxic megacolon, and perianal disease. In addition, surgery may be indicated in those patients who fail medical therapy. The recurrence rate after surgery approaches 100 percent.
When patients with Crohn's disease are discharged from the ED, alterations in their therapeutic regimen should be discussed with a consulting gastroenterologist. Close follow-up of these patients must be assured prior to discharge.
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