Abstract
Twenty-five children with granulomatous colitis were followed for a mean of 17 years to determine natural history and late results. In all the children the rectum was initially free of disease. Complications occurred in 84% and only three patients responded favorably to a medical program. Surgery was required in 68% (74 operations in 17 patients). Following 14 ileocolostomies there was proximal spread of disease in 7 and distal spread in 8 after varying periods. Nine ultimately required ileostomy, which also was no protection against proximal extension. The prognosis was worse when the terminal ileum was originally involved. The high incidence of postoperative complications and proximal extension encourages persistence in medical therapy, contrary to the attitude in managing ulcerative colitis in children. The surgical procedure of choice when the rectum is free of disease is an ileocolostomy, since anticipated extension might not occur for a prolonged period of time.
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