Surgery for Crohn's disease in 28 children with the presence of acid-fast bacilli

Abstract

Obstruction, abscesses, fistulae, treatment failure, and growth retardation are not always absolute indications for surgery in Crohn's disease. At the Children's Hospital of Eastern Ontario we have advocated earlier surgery since 1974. Forty-eight cases are reviewed, 28 surgical (17 ileocecocolic, 2 ileocolic with normal rectum, 3 colorectal, 1 jejunal, 5 perineal). Ileocecocolic resection with primary anastomosis produced remission for at least 3.2 years. Remission in colectomy with primary ileocolic anastomosis was at least 1 year. Ileostomy and colorectal resection produced remissions for at least 1.66 years. After jejunal resection remission was 1.58 years. Significant height and weight gains in over 80% of cases encourage earlier surgery. Adequate medical treatment has not often influenced the disease process. Surgery does not remove useful, medically restorable to normal bowel. Most postoperative cases required no medications and none jave required steroids. Permanent cure of anorectal disease alone was not achieved. Surgical mortality was 0%. The average hospital stay was 11.6 days. Postoperative fistulae occurred in 1 case and closed spontaneously. Mycobacterium tuberculosis was found in 2 resected specimens and in 1 human tubercle bacilli were cultured after 5 months. Both cases healed spontaneously, and both were otherwise undistinguishable from the other cases of Crohn's disease. Both were white, native-born Canadians. On examination of all the other resected specimens in our series, no acid-fast bacilli were seen.