My daughter was diagnosed with a stricture in March 2006. She is doing fine now on Entocort and plans to avoid surgery as long as she possibly can.
For people whose quality of life is low because meds are not working and natural remedies are exhausted, it probably makes sense to consider surgery. It might also make sense to consider sugery if side effects of meds are too toxic.
Our reasons for taking a pass on surgery: first and foremost, meds and diet are working with no side effects. Some others: surgery tends to lead to more surgery; crohn's symptoms can show up within months, days, hours or even immediately after surgery; clinical trials have shown patients with resection are less likely to respond to some of the meds being trialed; and any surgery can cause complications.
The following link will take you to a pretty good discussion about surgery for Crohn's:
The following link mentions perforation is rare in Crohn's Disease:
The following link corroborates perforation is rare: "Spontaneous free perforation is an uncommon event in the natural history of Crohn's disease. It occurred in 21 of 1415 patients (1.5%) admitted with Crohn's disease to The Mount Sinai Hospital between 1960 and 1983. The mean duration from onset of Crohn's disease to occurrence of perforation was 3.3 years. Ten patients had small bowel perforation, ten patients had large bowel perforation, and one patient had simultaneous perforation of both ileum and cecum. The incidence of perforation in disease segments of small bowel was 1.0% (jejunum 6.0%, ileum 0.7%), and in the colon, 1.3%. Besides the 21 patients with spontaneous free perforation, an additional nine patients had spontaneous free rupture of an abscess into the peritoneal cavity. The mean duration from onset of Crohn's disease to rupture of abscess was 8.5 years. All 30 patients had surgery within 24 hours of perforation or rupture. All 21 patients with spontaneous free perforations survived, as did all but one of the nine patients with perforated abscess. The cornerstone of the treatment of ileocolonic lesions perforating into the general peritoneal cavity is proximal diversion with delayed reconstruction of intestinal continuity whenever possible. With perforation of the small bowel, primary reanastomosis is possible in selected patients."
Daughter (20) Dx'd Crohn's 3/06. Misdiagnosed for two years, including by top pediatric Crohn's specialist as stress and needing more fiber but landed in hospital in 3/06 with cramps, vomiting, stricture. Now in remission with Entocort 3 mg (one pill), SCD multivitamin, yogurt, vit D3 1800IU, 900+ mg calcium, 50 mg B complex vit, 25 mg iron. No longer on SCD diet.