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Updated: Sep 10, 2025
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Surgical management of very early onset inflammatory bowel disease
Sarah J Ullrich1, Annie Le-Nguyen1, Monica Holder1
1Colorectal Center at Cincinnati Children's Hospital, Division of Pediatric General & Thoracic Surgery, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
Insights
Surgical intervention is needed in 22% of very early-onset inflammatory bowel disease (VEO-IBD) patients. Factors like Black race, early diagnosis, and disease severity influence the need for surgery in VEO-IBD.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Surgery
- Inflammatory Bowel Disease Research
Background:
- Very early-onset inflammatory bowel disease (VEO-IBD) incidence is rising in children under six.
- VEO-IBD presents unique clinical features, treatment responses, and outcomes.
- The role of surgical intervention in VEO-IBD remains poorly understood.
Purpose of the Study:
- To examine the surgical management strategies and outcomes in pediatric patients diagnosed with VEO-IBD.
- To identify factors associated with the need for surgical intervention in this population.
Main Methods:
- A retrospective review of 121 VEO-IBD patients diagnosed between January 2008 and May 2024 at a single institution.
- Data collected included demographics, clinical characteristics, and disease severity.
- Descriptive statistics were used for data analysis.
Main Results:
- Crohn's disease was the most common phenotype (61.2%), often affecting the colon (62.8%).
- Surgical intervention was required in 21.5% of patients, with ostomy creation and bowel resection being common procedures.
- Black race, diagnosis before one year of age, decreased height velocity, perianal disease, and disease severity were significantly associated with operative intervention.
Conclusions:
- This study, the largest single-center review, found a 22% surgical intervention rate in VEO-IBD.
- Key factors influencing surgical need include Black race, age at diagnosis, disease severity, decreased height velocity, and perianal disease.
- Further research is essential to clarify the role and outcomes of surgery in managing heterogeneous VEO-IBD cases.
Purpose:
The incidence of inflammatory bowel disease in children under six years of age, known as very early-onset inflammatory bowel disease (VEO-IBD) has been increasing. VEO-IBD has distinct clinical phenotypes, treatment response and outcomes, however the role of surgical intervention remains poorly understood. This study examines surgical management in this population.
Methods:
We conducted a retrospective review of patients diagnosed with VEO-IBD at a single institution between January 2008 and May 2024. Data on demographics, clinical characteristics, and measures of disease severity were collected and analyzed using descriptive statistics.
Results:
A total of 121 patients met criteria for inclusion. The majority of patients were diagnosed with a Crohn's disease phenotype (n = 74, 61.2 %). Disease was most frequently isolated to the colon (n = 76, 62.8 %) or ileocolic (n = 38, 31.4 %). Approximately half of the patients (n = 60, 49.6 %) had previously received treatment at another facility. Surgical intervention was required in 26 patients (21.5 %). Of those who had surgery, 69.2 % had an ostomy created, 34.6 % had a bowel resection, 26.9 % had an anorectal exam under anesthesia. Factors significantly associated with operative intervention included Black race (P = 0.011), diagnosis before one year of age (P = 0.022), height velocity ≤ 2SD (P = 0.005), perianal disease (0.005) and disease severity (P = 0.019). Notably, family history (P = 0.226), positive genetic findings (P = 0.459), disease classification (P = 0.991), and disease location were not significantly linked with the need for surgical intervention. Among children who had a bowel resection or stoma creation, there was no statistically significant difference in post-operative height velocity or medication usage.
Conclusion:
This study represents the largest single-center review of surgical interventions in VEO-IBD patients, with a 22 % intervention rate. Black race, age at diagnosis, disease severity, decreased height velocity and presence of perianal disease significantly influence surgical need. Given the heterogeneity of VEO-IBD, further research is necessary to elucidate the role of surgery, as well as surgical outcomes in managing this complex condition.
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