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Perianal Crohn's Disease in Children and Adolescents
Annika Mutanen1, Mikko P Pakarinen1
1Department of Pediatric Surgery, Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
Insights
Childhood-onset Crohn's disease is rising globally and often presents aggressively with perianal complications. Early, multidisciplinary care is crucial for managing pediatric perianal Crohn's disease effectively.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Gastroenterology
Background:
- Crohn's disease incidence is increasing worldwide, particularly in children.
- Childhood-onset Crohn's disease is characterized by aggressive progression and frequent ileocecal/colonic involvement.
- Perianal disease is a common and severe complication in pediatric Crohn's disease.
Purpose of the Study:
- To provide an updated review on perianal Crohn's disease in children and adolescents.
- To cover epidemiology, pathophysiology, diagnostics, and management strategies.
- To highlight the aggressive nature and complications of pediatric perianal Crohn's disease.
Main Methods:
- Systematic clinical evaluation
- Endoscopic assessment
- Advanced imaging studies
- Combined medical and surgical management strategies
Main Results:
- Perianal Crohn's disease in children often leads to severe complications like sepsis, fistulae, incontinence, and strictures.
- These complications significantly impair quality of life and may necessitate fecal diversion.
- A multidisciplinary approach is essential for optimal patient care.
Conclusions:
- Perianal Crohn's disease in pediatric populations requires specialized, comprehensive management.
- Aggressive disease course and complications underscore the need for timely and effective interventions.
- Multidisciplinary care integrating medical and surgical expertise is key to improving outcomes.
Abstract:
The incidence of Crohn's disease is increasing worldwide. The clinical course of childhood onset Crohn's disease is particularly aggressive with characteristic disease localization in the ileocecal region and colon, often associated with perianal disease. Severe complications of perianal disease include recurrent perianal sepsis, chronic fistulae, fecal incontinence, and rectal strictures that impair quality of life and may require fecal diversion. Care of patients with perianal Crohn's disease requires a multidisciplinary approach with systematic clinical evaluation, endoscopic assessment, and imaging studies followed by combined medical and surgical management. In this review, we provide an update of the epidemiology, pathophysiology, diagnostics, and management of perianal Crohn's disease in children and adolescents.
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