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Surgical management of complicated Crohn's disease

Sarah J Ullrich1, Jason S Frischer1

  • 1Colorectal Center at Cincinnati Children's Hospital, Divison of Pediatric General & Thoracic Surgery, 3333 Burnet Ave, MLC-2024, Cincinnati, OH 45229, USA.

Seminars in Pediatric Surgery
|April 20, 2024
PubMed

Insights

Surgical management of pediatric Crohn's disease focuses on palliative care, prioritizing intestinal length preservation and addressing complications. Key considerations include multidisciplinary risk assessment and growth impacts specific to pediatric patients.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Inflammatory Bowel Disease

Background:

  • Surgical management of pediatric Crohn's disease is palliative, focusing on sequelae and bowel length preservation.
  • Pediatric considerations include growth and developmental effects distinct from adult Crohn's disease.
  • Multidisciplinary evaluation of risks and quality of life is crucial before surgery.

Purpose of the Study:

  • To outline current surgical strategies for pediatric Crohn's disease.
  • To highlight pediatric-specific challenges in Crohn's disease management.
  • To emphasize a multidisciplinary approach for optimal patient outcomes.

Main Methods:

  • Review of surgical principles for pediatric Crohn's disease.
  • Discussion of approaches to intra-abdominal abscesses and fibrostenotic strictures.
  • Consideration of fecal diversion for refractory proctocolitis.

Main Results:

  • Percutaneous drainage is preferred for intra-abdominal abscesses; surgery is reserved for unstable or refractory cases.
  • Strictureplasty is recommended for fibrostenotic disease to maximize bowel length preservation.
  • Fecal diversion without proctocolectomy is the initial approach for medically refractory Crohn's proctocolitis.

Conclusions:

  • Pediatric Crohn's disease surgery requires tailored approaches considering growth and development.
  • Conservative measures like percutaneous drainage and strictureplasty are favored.
  • Fecal diversion is a key strategy for specific pediatric Crohn's presentations.

Keywords:
Crohn's diseaseInflammatory bowel diseasePediatric surgery

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