The surgical management of terminal ileal and right colon Crohn's disease in children

Abstract

During a recent 7-year period, 11 children between the ages of 6 and 15 years underwent intestinal resection for terminal ileal and right colon Crohn's disease. The indications for surgery included: failure of medical therapy in 8 patients, growth retardation in 4, stricture formation in 5, abscess formation in 2, the presence of an enterocutaneous fistula in 2, and intestinal obstruction in 1. All children underwent resection of the grossly involved bowel. The sites of involvement were the terminal ileum and the ileocecal valve in 7 patients and the terminal ileum, cecum, and proximal right colon in 4. There were no postoperative complications or mortality. The follow-up in these patients ranged from 1 to 7 years with a mean of 2.6 years. Thus far, all patients are clinically well and off all medications. Only one questionable recurrence was seen in a teenage girl who was readmitted 3 years after a resection of her terminal ileum and cecum for Crohn's disease. A recent small-bowel series 4 years after the recurrence shows no evidence of Crohn's disease. The initial excellent results with resectional therapy in this small subgroup of children with Crohn's disease has prompted us to consider earlier surgical intervention in these patients.