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Surgery in Pediatric Crohn’s Disease: Indications, Timing and Post-Operative Management

김승
대한소아소화기영양학회 (The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition)|2017.03|Pediatric Gastroenterology, Hepatology & Nutrition|제20권 제1호|pp. 14-21

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키워드

ChildInflammatory bowel diseasesCrohn diseaseColorectal surgery
주제분류소아과학

초록

Pediatric onset Crohn’s disease (CD) tends to have complicated behavior (stricture or penetration) than elderly onset CD at diagnosis. Considering the longer duration of the disease in pediatric patients, the accumulative chance of surgical treatment is higher than in adult onset CD patients. Possible operative indications include perianal CD, in-testinal stricture or obstruction, abdominal abscess or fistula, intestinal hemorrhage, neoplastic changes and medi-cally untreatable inflammation. Growth retardation is an operative indication only for pediatric patients. Surgery can affect a patient’s clinical course, especially for pediatric CD patient who are growing physically and mentally, so the decision should be made by careful consideration of several factors. The complex and diverse clinical conditions hinder development of a systemized treatment algorithm. Therefore, timing of surgery in pediatric CD patients should be determined with individualized approach by an experienced and well organized multidisciplinary inflammatory bowel disease team. Best long-term outcomes will require proactive post-operative monitoring and therapeutic mod-ifications according to the conditions.

Abstract

Pediatric onset Crohn’s disease (CD) tends to have complicated behavior (stricture or penetration) than elderly onset CD at diagnosis. Considering the longer duration of the disease in pediatric patients, the accumulative chance of surgical treatment is higher than in adult onset CD patients. Possible operative indications include perianal CD, in-testinal stricture or obstruction, abdominal abscess or fistula, intestinal hemorrhage, neoplastic changes and medi-cally untreatable inflammation. Growth retardation is an operative indication only for pediatric patients. Surgery can affect a patient’s clinical course, especially for pediatric CD patient who are growing physically and mentally, so the decision should be made by careful consideration of several factors. The complex and diverse clinical conditions hinder development of a systemized treatment algorithm. Therefore, timing of surgery in pediatric CD patients should be determined with individualized approach by an experienced and well organized multidisciplinary inflammatory bowel disease team. Best long-term outcomes will require proactive post-operative monitoring and therapeutic mod-ifications according to the conditions.

참고문헌 (47)

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