Format

Send to

Choose Destination
J Pediatr Surg. 2018 May;53(5):964-967. doi: 10.1016/j.jpedsurg.2018.02.023. Epub 2018 Feb 8.

Long-term outcomes for children with very early-onset colitis: Implications for surgical management.

Author information

1
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
2
Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
3
Department of Surgery, University of Toronto, Toronto, ON, Canada.
4
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: jacob.langer@sickkids.ca.

Abstract

PURPOSE:

The timing of J-pouch surgery following colectomy for children with very early-onset colitis is controversial, with some advocating early reconstruction and others delaying reconstruction because of fear that the colitis may be owing to Crohn's disease (CD). We sought to determine the long-term incidence of CD in this population and whether there may be clinical features that predict the risk of CD.

METHODS:

Children with noninfectious colitis diagnosed prior to age 10, who underwent subtotal colectomy and ileostomy from 2000 to 2015, were reviewed.

RESULTS:

Twenty-five children were identified. Median age at presentation was 5.4years. Four were initially diagnosed with CD (16%), 14 with ulcerative colitis (UC) (56%), and 7 with inflammatory bowel disease unclassified (IBD-U) (28%). Eight eventually had pouch surgery. Five of the children with an initial diagnosis of UC or IBD-U developed findings that changed the diagnosis to CD at a median age of 13.4 (range 10.3 to 16.7) years. None had any indicators of CD at the initial presentation.

CONCLUSIONS:

Approximately one quarter of patients with very early-onset colitis originally diagnosed as UC or IBD-U had a reclassification in diagnosis to CD over time. J-pouch reconstruction should be delayed until adolescence in children with very early-onset colitis.

LEVEL OF EVIDENCE:

2C.

KEYWORDS:

Crohn's disease; Ileal pouch-anal anastomosis; Inflammatory bowel disease; J-pouch reconstruction; Ulcerative colitis; Very early-onset colitis

PMID:
29534824
DOI:
10.1016/j.jpedsurg.2018.02.023
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center