Surgical treatment of Crohn's disease.
Of 93 children with Crohn's disease treated at the Hôpital Sainte-Justine between 1967 and 1979, 39 were operated on. Ten had abscesses and anal fistulas drained and in 29 the bowel was resected. The mean age of the children was 13 years. The average time between onset and diagnosis for both the medical and surgical groups was 13 months. Medical treatment failed in 25 patients after an average time of 22 +/- 17 months. Fourteen patients had an initial laparotomy, with a false diagnosis of appendicitis in 8, abdominal tumour in 2 and Meckel's diverticulum in 1. Indications for operation were: intestinal obstruction, bowel fistula, intra-abdominal abscess, gastrointestinal hemorrhage, growth failure and toxic megacolon. There were no deaths and only two postoperative infections. Crohn's disease seems to be becoming more frequent, more severe and starting earlier in life. Three to 6 weeks of preoperative preparation with enteral and parenteral nutrition allows operation to be performed under safer conditions. Although the recurrence rate after operation is still high, there is no doubt that the children enjoy a better quality of life, growth and a 50% chance of being disease-free 10 years later.
D000293:Adolescent; D000328:Adult; D002648:Child; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male