DIAGNOSTIC LAPAROSCOPY IN CHILDHOOD CROHNS-DISEASE

In some children, contrast radiography and endoscopy fail to confirm s uspected Crohn's disease, or fail to evaluate the extent of disease. T his report documents seven cases in which laparoscopy was used to look for creeping mesenteric fat involving the small intestine, a patholog ical finding reported only for Crohn's disease. One child had extensiv e Crohn's colitis and possible terminal ileitis that remained clinical ly disabling despite intensive immunosuppression therapy. The lack of creeping fat in the small intestine was used to justify colon resectio n and forego further aggressive medical therapy. The patient had compl ete resolution of her symptoms after the colectomy. Six children had s uspected Crohn's disease and underwent diagnostic laparoscopy after ot her studies were inconclusive. In three, creeping mesenteric fat of th e 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 mesente ric fat, and subsequently other pathological conditions were identifie d. The usual radiographic and endoscopic studies will diagnose most ca ses of Crohn's disease, but this report emphasizes that, in select cas es in which other investigations are inconclusive, laparoscopy can be useful to search for creeping mesenteric fat, a finding characteristic of Crohn's disease. Copyright (C) 1996 by W.B. Saunders Company