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Surgical care of the pediatric Crohn's disease patient
1Department of Surgery, Johns Hopkins School of Medicine, Johns Hopkins Children's Center, 1800 Orleans St, Bloomberg Suite 7335, Baltimore, MD 21287.
Insights
Surgery is crucial for pediatric Crohn's disease (CD), addressing aggressive phenotypes and growth failure. Timely surgical intervention significantly impacts children's physical and mental development, focusing on small intestinal and ileocecal disease.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Inflammatory Bowel Disease
Background:
- Medical management of inflammatory bowel disease has advanced, yet surgery remains vital for pediatric Crohn's disease (CD).
- Pediatric CD often presents with a more aggressive phenotype compared to adult CD.
- Children with CD have unique considerations, including growth failure, impacting surgical decision-making.
Purpose of the Study:
- To provide a comprehensive overview of surgical care for pediatric Crohn's disease.
- To emphasize the specific surgical treatment strategies for small intestinal and ileocecal involvement in pediatric CD.
- To highlight the transformative potential of surgery on a child's physical and mental maturation.
Main Methods:
- This monograph synthesizes current knowledge on surgical management.
- It focuses on the distinct needs of pediatric patients compared to adults.
- Emphasis is placed on operative care for small bowel and ileocecal CD.
Main Results:
- Surgery is not curative but can significantly alter the disease course in children.
- Appropriately timed surgical interventions can positively impact physical and mental development.
- Specific surgical approaches are tailored to the pediatric population, considering growth and development.
Conclusions:
- Surgery plays an indispensable role in managing pediatric Crohn's disease, particularly for aggressive phenotypes and growth issues.
- Pediatric surgeons must consider unique factors in children, differentiating their approach from adult CD care.
- Strategic surgical management can profoundly improve long-term outcomes and quality of life for pediatric CD patients.
Abstract:
Despite the significant advances in the medical management of inflammatory bowel disease over the last decade, surgery continues to play a major role in the management of pediatric Crohn's disease (CD). While adult and pediatric Crohn's disease may share many clinical characteristics, pediatric Crohn's patients often have a more aggressive phenotype, and the operative care given by the pediatric surgeon to the newly diagnosed Crohn's patient is very different in nature to the surgical needs of adult patients after decades of disease progression. Children also have the unique surgical indication of growth failure to consider in the overall clinical decision making. While surgery is never curative in CD, it has the ability to transform the disease process in children, and appropriately timed operations may have tremendous impact on a child's physical and mental maturation. This monograph aims to address the surgical care of Crohn's disease in general, with a specific emphasis on the surgical treatment of small intestinal and ileocecal involvement.
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