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Surgical management of Crohn's disease in children
1Children's Hospital-St. Paul, Minnesota, USA.
Insights
Crohn
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Inflammatory Bowel Disease
Background:
- Crohn's disease is a chronic transmural inflammatory condition affecting the intestinal tract, often the terminal ileum and colon.
- Its etiology remains undetermined, sharing features with ulcerative colitis.
- Surgical intervention for Crohn's disease primarily addresses complications, with increasing incidence reported in children.
Purpose of the Study:
- To review the surgical principles and adjuncts for managing Crohn's disease complications in pediatric patients.
- To evaluate the efficacy and limitations of various surgical techniques in this population.
Main Methods:
- Review of surgical management strategies for Crohn's disease.
- Emphasis on preserving intestinal length and the role of strictureplasty.
- Discussion of discouraged procedures like restorative proctocolectomy and Kock pouch.
Main Results:
- Strictureplasty is a beneficial adjunct for managing fibrotic strictures in the small intestine, effective in both children and adults.
- Procedures like restorative proctocolectomy and Kock pouch are associated with significant complications in Crohn's disease patients.
- Surgery can restore health and well-being in pediatric patients with Crohn's disease, though it does not eradicate the disease.
Conclusions:
- Surgical management of Crohn's disease in children focuses on relieving complications while maximizing intestinal length.
- Strictureplasty is a valuable technique for specific cases of Crohn's disease.
- While not curative, surgical interventions can significantly improve the quality of life for pediatric patients.
Abstract:
Crohn's disease is a chronic, transmural inflammatory disease of the intestinal tract most frequently involving the terminal ileum and colon. It is a disorder of undetermined etiology that shares many pathophysiologic clinical aspects with chronic ulcerative colitis. Surgical treatment of Crohn's disease continues to be generally limited to the treatment of the complications of the disease. It is being reported with increasing frequency in children of all ages. The surgical principle generally adhered to is to remove only enough intestine to relieve the complication but to maintain as much intestinal length as possible. Because of this requirement, strictureplasty has become a worthwhile surgical adjunct, especially when dealing with multiple minimally inflamed fibrotic strictures in the small intestine. It has been as beneficial in children as in adults. Restorative proctocolectomy and the Kock pouch procedure are discouraged in patients with known Crohn's disease because of numerous subsequent complications. It is very important that surgeons and physicians realize that although the disease process cannot be eradicated by surgery, the health and well-being of a child or teenager can be restored to normal for prolonged periods, if not permanently.