OUTCOME AFTER SURGICAL INTERVENTION IN CHILDREN WITH CHRONIC INFLAMMATORY BOWEL-DISEASE

A retrospective review of 32 children and adolescents (18 males and 14 females) with chronic inflammatory bowel disease (CIBD) requiring. su rgery was undertaken. These patients were followed between 1979 and 19 92. Their age range was from 4 to 17 years at the time of diagnosis (m ean age, 11 years). The interval between the time of diagnosis and sur gery ranged from 2 months to 11 years (mean, 3.7 years), Ten patients had ulcerative colitis and 22 had Crohn's disease. These patients repr esented 12 per cent of patients with CIBD seen at the Gastroenterology Clinic of Children's Hospital of Michigan during these 13 years. Indi cations for surgery included failure of medical treatment (seven patie nts), localized disease with significant side effects of therapy (nine ), partial or complete obstruction (five), growth retardation (six), p erforation (two), abscess and fistula (three), The extent of disease w as as follows: panenteric, 2 patients; enteric, 2 patients; ileocecal, 15 patients; and colonic, 13 patients. In 15 patients (47%) surgery l ed to complete relief of symptoms for a minimum of 1 year after surger y. Seven patients (22%) had recurrence of symptoms that were controlle d by medical treatment. Two patients required a second surgery and add itional medical and nutritional treatment. All six patients having sur gery for growth retardation showed catch-up growth in weight and heigh t, We conclude that surgery can decrease morbidity and improve quality of life in CIBD patients, Best results are obtained in patients with localized disease.