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Surgery in Pediatric Crohn Disease: Case Series from a Single Tertiary Referral Center
Rita Lourenço1, Sara Azevedo2, Ana Isabel Lopes2
1Pediatric Department, Hospital do Divino Espírito Santo de Ponta Delgada, Azores, Portugal.
Insights
Surgery in pediatric Crohn disease (CD) is effective for managing complications and maintaining remission. This study found that surgical intervention in children with CD led to significant clinical improvement and nutritional recovery, with a low rate of relapse.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Crohn disease (CD) carries a significant lifelong risk of surgery.
- Limited data exist on surgical outcomes in pediatric CD patients, especially during the era of biologic therapies.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of pediatric and adolescent CD patients who underwent surgical intervention.
- To evaluate the efficacy of surgery in managing CD complications and maintaining remission in a pediatric cohort.
Main Methods:
- Retrospective, cross-sectional study of pediatric CD patients undergoing intra-abdominal surgery over 11 years.
- Data collection included patient demographics, disease characteristics (Paris classification), preoperative and postoperative treatments, and clinical outcomes.
Main Results:
- Eight of 50 CD patients (16%) underwent surgery, with a median age of 12.0 years at diagnosis.
- Common surgical indications included stricturing and penetrating disease behaviors.
- Postoperatively, seven of eight patients achieved clinical remission with significant weight and height recovery; one patient relapsed after 3.2 years.
Conclusions:
- Surgical treatment is a viable option for selected pediatric CD cases, effectively resolving acute issues and aiding remission.
- Surgery facilitates a disease-free interval and promotes nutritional recovery in pediatric patients with Crohn disease.
- The study highlights the positive impact of surgical intervention on long-term outcomes for children with Crohn disease.
Introduction:
There is a recognized increase of lifelong surgery risk in Crohn disease (CD). Outcome data concerning surgery in children, particularly in the biological era, are limited.
Aim:
To characterize the clinical profile and the clinical outcome in children and adolescents with CD who underwent surgical intervention, in a single tertiary referral center.
Methods:
Retrospective, cross-sectional study, including pediatric patients with CD undergoing intra-abdominal surgery in the last 11 years.
Results:
Included eight of 50 CD total patients (16%); six female; median age at CD diagnosis of 12.0 years; Paris classification: (a) location: ileocolonic (5), colonic (1), upper disease (1), ileocolonic/upper disease (1); (b) behavior: stricturing (4), nonstricturing nonpenetrating (2), penetrating (1), both penetrating and stricturing disease (1); growth delay (2). Six children received thiopurines, five mesalazine, three corticosteroids and four anti-TNF therapy, preoperatively. Surgery followed diagnosis by a median of 2.9 years. Median PCDAI at the time of surgery was 35.0. Elective surgery was performed in six patients and emergency surgery in two, without major complications. Five children received anti-TNF and three thiopurines post-operatively. Within the follow-up period (median 1.7 years), relapse occurred in one child (3.2 years after intervention); the remaining seven patients persist in clinical remission. Median PCDAI in the last evaluation was 6.3. Weight and height recovery was observed in seven patients, at last follow-up.
Conclusion:
Surgical treatment of CD is a valid alternative in selected cases, contributing to the resolution of acute complications and maintenance of remission, allowing disease-free interval and nutritional recovery.
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