Surgical management of Crohn's disease in children.

Crohn's disease is more common in children than has generally been appreciated. Based on a 12 year review of cases from the UCLA Hospital, approximately 57 per cent of children with this disease require operation for the management of its complications.In 28 of 50 children undergoing operation, the disease was confined to the terminal ileum and ascending colon. Each of these patients underwent localized resection with ileocolostomy, although two children had preliminary cutaneous ileostomy; 25 per cent had mild recurrence within 5 years but only two required reoperation. Obstruction is the major symptom in this group, whereas perianal fistulas and abscesses are uncommon.Approximately one third of the patients (17 of 50) had primary Crohn's disease of the colon and rectum. Diarrhea and growth failure are common with this form of the disease. Eighty-two per cent had anal fistulas and abscesses requiring surgical treatment. Although intestinal diversion or intestinal resection, or both, with reanastomosis were tried in the majority of these patients, 14 of the 17 eventually required proctocolectomy for relief of severe symptoms. Recurrent disease in the terminal ileum occurred in 64 per cent of these patients.Only a rare patient with granulomatous disease of the small intestine alone will benefit from surgical resection.Bowel rest and total parenteral nutrition before and after resectional surgery appear to minimize the likelihood of postoperative obstruction or anastomotic leak and also to reduce the length of intestine required for resection.