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Perianal complications of pediatric Crohn's disease
S B Palder1, B Shandling, R Bilik
1Division of General Surgery, Hospital For Sick Children, Toronto, Ontario, Canada.
Insights
Perianal disease (PD) is a common complication in pediatric Crohn's disease, often appearing early. While most cases are benign, meticulous care and potential metronidazole therapy are key, with limited surgical intervention needed.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease
- Surgical Gastroenterology
Background:
- Perianal disease (PD) is a frequent complication in pediatric Crohn's disease (CD).
- Understanding the incidence, presentation, and management of PD in children with CD is crucial for effective patient care.
Purpose of the Study:
- To review the management of perianal disease in pediatric patients with Crohn's disease.
- To analyze the occurrence, symptoms, and treatment outcomes of PD in this population.
Main Methods:
- Retrospective review of 325 pediatric patients diagnosed with Crohn's disease.
- Analysis of patient demographics, PD presentation, disease course, interventions, and treatment responses.
Main Results:
- 62% of pediatric CD patients developed PD, with fissures being most common (51%).
- PD sometimes presented before other CD symptoms, and 42 patients developed it later.
- Limited surgery was required for 12% of patients; metronidazole showed potential benefit in 72% of treated cases.
Conclusions:
- Perianal disease is a common and often early manifestation of Crohn's disease in children.
- Conservative management, including perineal care and potentially metronidazole, is advocated.
- Surgical intervention for PD in pediatric CD patients should be reserved for severe or progressive cases.
Abstract:
The management of perianal disease (PD) in children with Crohn's disease was reviewed. Of 325 patients (184 boys), 200 (62%) developed PD. The mean age at diagnosis of Crohn's disease was 11.2 years (range, 5 to 17 years). Skin tags were present in 114 (35%) patients, fissures in 165 (51%), fistulas in 41 (15%), and perirectal abscesses in 47 (13%). One hundred fifty-three patients had PD as one of the first symptoms; 71 of these had complete remission of PD and the remaining 82 had chronic symptoms. Forty-two patients were initially free of PD, only to develop it later. PD occurred in 50% of patients with gastroduodenal Crohn's disease, 57% with jejunal, 68% with ileal, 64% with ileocecal, 60% with ileocolic, and 51% with colonic. Local minor operation was necessary in 38 (12%) patients, fistulotomy in 12, and abscess drainage in 26. Four patients required either intestinal resection and/or enterostomy for progressive PD. Fifty-three patients received metronidazole, with amelioration in 38. It is concluded that PD is a common complication of Crohn's disease in children and adolescents. Its presentation may antedate that of the primary disease. Most PD follows a benign course. There is a limited role for operation, but a need for meticulous perineal care and a potential benefit with metronidazole therapy. We advocate conservatism in the management of perianal complications of Crohn's disease in pediatric patients.