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2016 ; 23
(4
): 191-196
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Surgery in Pediatric Crohn Disease: Case Series from a Single Tertiary Referral
Center
#MMPMID28868459
Lourenço R
; Azevedo S
; Lopes AI
GE Port J Gastroenterol
2016[Jul]; 23
(4
): 191-196
PMID28868459
show ga
INTRODUCTION: There is a recognized increase of lifelong surgery risk in Crohn
disease (CD). Outcome data concerning surgery in children, particularly in the
biological era, are limited. AIM: To characterize the clinical profile and the
clinical outcome in children and adolescents with CD who underwent surgical
intervention, in a single tertiary referral center. METHODS: Retrospective,
cross-sectional study, including pediatric patients with CD undergoing
intra-abdominal surgery in the last 11 years. RESULTS: Included eight of 50 CD
total patients (16%); six female; median age at CD diagnosis of 12.0 years; Paris
classification: (a) location: ileocolonic (5), colonic (1), upper disease (1),
ileocolonic/upper disease (1); (b) behavior: stricturing (4), nonstricturing
nonpenetrating (2), penetrating (1), both penetrating and stricturing disease
(1); growth delay (2). Six children received thiopurines, five mesalazine, three
corticosteroids and four anti-TNF therapy, preoperatively. Surgery followed
diagnosis by a median of 2.9 years. Median PCDAI at the time of surgery was 35.0.
Elective surgery was performed in six patients and emergency surgery in two,
without major complications. Five children received anti-TNF and three
thiopurines post-operatively. Within the follow-up period (median 1.7 years),
relapse occurred in one child (3.2 years after intervention); the remaining seven
patients persist in clinical remission. Median PCDAI in the last evaluation was
6.3. Weight and height recovery was observed in seven patients, at last
follow-up. CONCLUSION: Surgical treatment of CD is a valid alternative in
selected cases, contributing to the resolution of acute complications and
maintenance of remission, allowing disease-free interval and nutritional
recovery.