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Surgery for Crohn's disease in infants and children
H I Patel1, A M Leichtner, A H Colodny
1Department of Surgery, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Insights
Pediatric Crohn's disease management often requires surgery, with nearly half of children needing resection within five years due to treatment failure or complications. Disease course in children with Crohn's disease is unpredictable, necessitating careful monitoring.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
- Pediatric Surgery
Background:
- Crohn's disease presents variably in children.
- Current medical therapies are used to manage pediatric Crohn's disease.
- Surgical intervention is sometimes necessary for pediatric Crohn's disease.
Purpose of the Study:
- To assess the frequency and indications for surgery in children with Crohn's disease.
- To evaluate the role of medical therapy in managing pediatric Crohn's disease.
- To understand the long-term outcomes of surgical interventions for pediatric Crohn's disease.
Main Methods:
- Retrospective review of 204 pediatric Crohn's disease cases.
- Analysis of surgical indications and procedures.
- Assessment of disease recurrence and follow-up duration.
Main Results:
- 46% of children (94/204) required surgical resection.
- Indications included medical therapy failure (47%), abscess/perforation (16%), fistulas (14%), obstruction (16%), hemorrhage (4%), and appendectomy (3%).
- Probability of surgery was 28.8% at 3 years and 47.2% at 5 years post-diagnosis. Recurrence after resection occurred in 40 patients.
Conclusions:
- The course of pediatric Crohn's disease is unpredictable.
- Surgery is frequently required for pediatric Crohn's disease, often due to medical therapy failure or complications.
- Long-term follow-up is essential for monitoring disease recurrence after surgical intervention.
Abstract:
The course of Crohn's disease is quite variable in children. To assess the frequency and indications for surgery with current medical therapy, the authors reviewed the cases of 204 children (ages, 0.2 to 18.8 years at diagnosis, median, 12.8 years) who had Crohn's disease treated at a single institution from December 1968 to January 1994, with a median of 3.8 years of follow-up (range, 0.0 to 22.2 years). Ninety-four children (46%) required surgical resection for the following indications: (1) failure of medical therapy with persistent symptoms or growth retardation (n = 44, 47%), (2) intraabdominal abscess or perforation (n = 15, 16%), (3) fistula formation (n = 13, 14%), (4) obstruction (n = 15, 16%), (5) hemorrhage (n = 4, 4%), and (6) appendectomy at exploration for diagnosis (n = 3, 3%). The probability for surgery 3 years after diagnosis is 28.8% and by 5 years is 47.2%. Resections included ileocolectomy (71 children), colectomy (n = 16), small bowel resection (n = 4), and appendectomy (n = 3). Fourteen fistulas in 13 children required surgical intervention (7 enteroenteral, 3 enterovesical, 2 enterovaginal, and 2 enterocutaneous). The median duration from diagnosis to surgery for the fistulas was 2.6 years (range 0.1 to 9.8 years). Forty patients experienced recurring disease after resection during follow-up with a median of 1.8 years (range 0.4 to 18.1 years). The authors found that the course of the disease was unpredictable, with some children requiring early surgical intervention and others continuing with medical therapy for years.