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Surgical outcomes of very-early-onset ulcerative colitis: retrospective comparative study with older pediatric

Takashi Fumita1, Keita Terui2, Ryohei Shibata1

  • 1Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.

Pediatric Surgery International
|March 7, 2024
PubMed

Insights

Very-early-onset ulcerative colitis (VEO-UC) surgery outcomes are comparable to older pediatric UC patients. However, VEO-UC patients experienced more high-output ileostomy and prolonged central venous catheter use, presenting management challenges.

Area of Science:

  • Pediatric Gastroenterology
  • Surgical Outcomes
  • Inflammatory Bowel Disease

Background:

  • Very-early-onset ulcerative colitis (VEO-UC) is a rare, severe form of ulcerative colitis diagnosed in children under 6 years old.
  • Surgical management of VEO-UC presents unique challenges due to the patients' young age and developing bodies.
  • Comparative data on surgical outcomes between VEO-UC and older pediatric ulcerative colitis (UC) patients are limited.

Purpose of the Study:

  • To compare surgical outcomes, including complications and postoperative growth, between pediatric patients with VEO-UC and older pediatric patients with UC.
  • To identify specific challenges associated with surgical interventions in VEO-UC.
  • To inform clinical management strategies for VEO-UC.

Main Methods:

  • Retrospective observational study involving 57 pediatric patients with UC.
  • Patients were divided into two groups: VEO-UC (diagnosed <6 years) and older pediatric UC patients.
  • Surgical complications, postoperative growth (height Z-score), and central venous catheter (CVC) use were analyzed.

Main Results:

  • Six patients had VEO-UC; five underwent total colectomy.
  • Postoperative complication rates were similar, except for a significantly higher incidence of high-output ileostomy in VEO-UC patients (80% vs. 0%, p=0.02).
  • VEO-UC patients had a higher rate of long-term CVC placement (>90 days) (100% vs. 17%, p=0.02), but postoperative height growth was comparable between groups.

Conclusions:

  • Total colectomy for VEO-UC is comparable to that for older pediatric UC patients regarding overall complications and outcomes.
  • High-output ileostomy and prolonged CVC use are significant postoperative management challenges in VEO-UC.
  • Further research and tailored management strategies are needed for VEO-UC surgical patients.
Abstract

Keywords:
Catheter-related infectionEarly-onsetIleostomyInflammatory bowel diseasesPediatric ulcerative colitis

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