Diagnostic laparoscopy in childhood Crohn's disease

In some children, contrast radiography and endoscopy fail to confirm suspected Crohn's disease, or fail to evaluate the extent of disease. This report documents seven cases in which laparoscopy was used to look for creeping mesenteric fat involving the small intestine, a pathological finding reported only for Crohn's disease. One child had extensive Crohn's colitis and possible terminal ileitis that remained clinically disabling despite intensive immunosuppression therapy. The lack of creeping fat in the small intestine was used to justify colon resection and forego further aggressive medical therapy. The patient had complete resolution of her symptoms after the colectomy. Six children had suspected Crohn's disease and underwent diagnostic laparoscopy after other studies were inconclusive. In three, creeping mesenteric fat of the small intestine was found, and all three responded to treatment for Crohn's disease, with resolution of symptoms. The other three children had Crohn's disease excluded based on the absence of creeping mesenteric fat, and subsequently other pathological conditions were identified. The usual radiographic and endoscopic studies will diagnose most cases of Crohn's disease, but this report emphasizes that, in select cases in which other investigations are inconclusive, laparoscopy can be useful to search for creeping mesenteric fat, a finding characteristic of Crohn's disease.