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 surgery was undertaken. These patients were followed between 1979 and 1992. Their age range was from 4 to 17 years at the time of diagnosis (mean age, 11 years). The interval between the time of diagnosis and surgery ranged from 2 months to 11 years (mean, 3.7 years). Ten patients had ulcerative colitis and 22 had Crohn's disease. These patients represented 12 per cent of patients with CIBD seen at the Gastroenterology Clinic of Children's Hospital of Michigan during these 13 years. Indications for surgery included failure of medical treatment (seven patients), localized disease with significant side effects of therapy (nine), partial or complete obstruction (five), growth retardation (six), perforation (two), abscess and fistula (three). The extent of disease was as follows: panenteric, 2 patients; enteric, 2 patients; ileocecal, 15 patients; and colonic, 13 patients. In 15 patients (47%) surgery led to complete relief of symptoms for a minimum of 1 year after surgery. Seven patients (22%) had recurrence of symptoms that were controlled by medical treatment. Two patients required a second surgery and additional medical and nutritional treatment. All six patients having surgery for growth retardation showed catch-up growth in weight and height. We conclude that surgery can decrease morbidity and improve quality of life in CIBD patients. Best results are obtained in patients with localized disease.