SURGERY FOR CROHNS-DISEASE IN INFANTS AND CHILDREN

The course of Crohn's disease is quite variable in children. To assess the frequency and indications for surgery with current medical therap y, the authors reviewed the cases of 204 children (ages, 0.2 to 18.8 y ears at diagnosis, median, 12.8 years) who had Crohn's disease treated at a single institution from December 1968 to January 1994, with a me dian of 3.8 years of follow-up (range, 0.0 to 22.2 years), Ninety-four children (46%) required surgical resection for the following indicati ons: (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 explo ration 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 bower resection (n = 4), and appendectomy (n = 3). Fourteen fistulas in 13 children r equired surgical intervention (7 enteroenteral, 3 enterovesical, 2 ent erovaginal, and 2 enterocutaneous). The median duration from diagnosis to surgery for the fistulas was 2.6 years (range 0.1 to 9.8 years). F orty patients experienced recurring disease after resection during fol low-up with a median of 1.8 years (range 0.4 to 18.1 years). The autho rs found that the course of the disease was unpredictable, with some c hildren requiring early surgical intervention and others continuing wi th medical therapy for years. Copyright (C) 1997 by W.B. Saunders Comp any.