Crohn's Disease: Emergency and Crisis Scenarios

If you are experiencing a medical emergency, contact emergency services immediately: Emergency contacts and medical assistance

Crisis Scenario 1 — Acute Severe Flare

A severe Crohn's flare requires hospital-level management: IV hydration, bowel rest, IV corticosteroids, and gastroenterologist-directed care.

Warning signs requiring emergency care: - Severe abdominal pain with fever and/or rigors (possible abscess or perforation) - Profuse blood in stool with dizziness or rapid heart rate (GI haemorrhage) - Sudden severe abdominal pain with board-like rigidity (possible perforation — surgical emergency) - Inability to keep any food or fluids down, with signs of dehydration - High fever (> 38.5°C) with deteriorating abdominal symptoms on existing biologic therapy (possible serious infection — stop biologic, go to ER)

What to do: Go to the emergency room. Tell the treating team: your Crohn's diagnosis, disease location and behaviour, current medications (especially if on biologic), and most recent CRP/faecal calprotectin if known.

If you are on biologic therapy (adalimumab, infliximab, vedolizumab) and develop fever + sepsis features: hold the biologic until infection is ruled out or treated. Biologics suppress the immune system; a serious bacterial infection in a biologic-treated Crohn's patient is a medical emergency. The infectious disease team will need to be involved.

Crisis Scenario 2 — Perianal or Abdominal Abscess

Abdominal or perianal abscesses are one of the most common Crohn's surgical emergencies. They require: - Urgent imaging (CT abdomen or MRI pelvis for perianal) - Surgical drainage (radiological or surgical) - Antibiotic therapy (IV)

Perianal abscess warning signs: Painful swelling in the perianal area, fever, discharge, inability to sit. This is extremely painful and deteriorates rapidly without drainage.

A perianal abscess in Crohn's often heralds underlying perianal fistula — a track from the bowel to the skin. After abscess drainage, the gastroenterologist and colorectal surgeon will assess the fistula anatomy (MRI pelvis is standard) and plan definitive fistula management, which may involve anti-TNF therapy, seton placement, or fistulectomy.

What to do: Go to the ER. Abscesses require surgical drainage — they do not resolve with antibiotics alone. A colorectal surgeon will be involved. This is a CDL/PMB-covered surgical emergency, but colorectal surgeon shortfall is a significant gap exposure.

Crisis Scenario 3 — Bowel Surgery: The Financial Scenario

Your gastroenterologist or colorectal surgeon has recommended bowel resection (ileocaecal resection, right hemicolectomy, or stricturoplasty). What will this cost?

Let's focus on what we can control.

Before any planned surgery: 1. Ask the colorectal surgeon what they bill vs scheme rate. 2. Confirm your scheme's pre-authorisation for the procedure. 3. Notify your gap insurer of the planned admission. 4. Check for any bowel surgery sub-limit in your scheme benefit schedule. 5. Ask whether your scheme has preferred in-network colorectal surgeons — some schemes direct to specific providers.

In Hospital Right Now

If you have been admitted for a Crohn's flare, abscess drainage, or bowel surgery, act on these immediately:

1. Call your scheme's 24-hour authorisation line (on the back of your medical aid card) within 48 hours of admission. Provide your Crohn's CDL registration number.
2. Confirm who is treating you and at what rate. The gastroenterologist, colorectal surgeon, and anaesthesiologist may each bill above scheme rate — ask each one.
3. If you have gap cover, notify your gap insurer as soon as possible. Provide the date of admission, treating doctors' names and practice numbers, and the procedure being performed.
4. If you are on biologic therapy: inform your scheme's managed care team. Some schemes pause biologic payments during hospitalisation and need notification to restart post-discharge.
5. Ask for a discharge summary — your gastroenterologist and GP will need it to manage your recovery and restart medications.

Gap Cover: What It Does for Crohn's

Bottom line: csDMARD costs are CDL-funded. Gap cover matters for Crohn's in two scenarios: biologic-related hospitalisation complications, and bowel surgery (the more significant of the two for most patients).

Know your Crohn's cover before a flare or surgery. Run your AURA check