[Therapy of Crohn disease in internal medicine: short bowel syndrome and toxic megacolon].

In most cases a short-bowel syndrome is the consequence of extensive bowel resection for Crohn's disease with loss of gastrointestinal function. After operation the patients should be adapted to enteral feeding as soon as possible. The nutritional management is determined by the type of intestinal resection and length of remaining small and large bowel. Total parenteral nutrition for life-time is necessary in patients with less than 50 cm of small bowel. Toxic megacolon is a rare complication seen in Crohn's disease. Conservative therapy includes high doses of intravenous steroids, electrolyte replacement and hydration, antibiotics, decompression of the bowel as well as vigorous surveillance for potential complications. About 50% of the patients with toxic megacolon recover with conservative treatment alone. Surgical intervention should be performed not later than 48 hours after unsuccessful conservative therapy.