SURGICAL-TREATMENT OF CROHN DISEASE IN CHILDREN AND ADOLESCENTS - HOWCONSERVATIVE CAN THE PEDIATRICIAN BE

Thirty-eight children (21 male, 17 female, age 3-18 years), treated fo r Crohn disease in two Dutch university centres, were retrospectively studied in order to evaluate the results of conservative treatment and to find out in what way surgical treatment in this age group may have differed from treating adults with this disease. Both groups had an e qual distribution of age and sex. Diarrhoea with discharge of blood an d mucus, abdominal pain, nausea/vomiting, weight loss, fever and gener al discomfort were the most frequent presenting symptoms. Twenty-three children (60%) showed signs of malabsorption; 4 children (10%) had gr owth retardation. In 27 children (70%), 63 surgical procedures were pe rformed (2.4 operations per child). There was no surgical mortality. M ost operations were performed for ileocolitis and colon-only localizat ions needed most re-operations. Of the surgical procedures performed, 55% were excisional procedures. Already 3 years after the onset of sym ptoms, 50% of all children had had their first resection, whereas in a dults, 50% of the patients undergo surgery 8 years after disease onset . Eight children were treated with split ileostomy. In only one of the se children, operated for non-toxic colitis and severe steroid-depende nt growth retardation, could the colon eventually be saved. The time b etween the onset of symptoms and the first operation seems to be short er in children compared to adults. Severe malabsorption and growth ret ardation are additional specific indications for surgery for Crohn dis ease in childhood. The latter combined with non-toxic colitis, may per haps be the only indication left for performing split ileostomy in Cro hn disease.