title: Anti-TNF-α treatment for post-anastomotic ulcers and inflammatory bowel disease with Crohn's-like pathologic changes following intestinal surgery in pediatric patients.
abstract: OBJECTIVE
  To report a previously poorly recognized process of secondary formation of inflammatory bowel disease (IBD)-like process, specifically Crohn's-like changes in pediatric surgery patients who underwent major small bowel and colorectal surgery. We describe potential etiologies, presenting symptoms and treatment approaches.
  
  
  METHODS
  Retrospective chart review of patients with history of either chronic, partial gastrointestinal (GI) obstruction or Hirschsprung disease (HD) and subsequent histopathologic findings similar to IBD. Pathology and case histories were reviewed and treatments were compared.
  
  
  RESULTS
  Over the last 20 years, a total of nine patients were identified that had the diagnoses of either HD (n = 3) or chronic GI partial obstruction (n = 6) with subsequent development of histopathologic changes similar to those seen in IBD. Overall meantime to diagnosis of IBD-like changes after intestinal resection was 7.70 ± 5.6 years. Half of the patients were also being managed for short bowel syndrome (SBS), and associated GI symptoms may have prolonged the time to identifying these IBD-like changes. When SBS patients were excluded, mean time to IBD changes after pull through for HD was 2.4 ± 0.24 years and after chronic GI partial obstruction was 6.3 ± 2.1 years. Two of the nine patients who underwent a resection of this IBD-like lesion developed a recurrence of this lesion. Anti-TNF-α treatment was used in three of the GI partial obstruction cases: two with complete relief and one with partial response that was supplemented with steroids. Two HD patients were treated with anti-TNF-α and both had marked improvement of symptoms.
  
  
  CONCLUSIONS
  We describe IBD-like intestinal changes following intestinal resection in the pediatric age group. We also present the novel finding that these lesions are responsive to anti-IBD treatment, including anti-TNF-α, and recommend it as part of the medical treatment regiment offered for such patients.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI, 48109-4211, USA, jennjfreeman@me.com.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Freeman
authors.forename: Raja
authors.initials: R
authors.lastname: Rabah
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
authors.forename: Aldo
authors.initials: A
authors.lastname: Maspons
authors.forename: Donald
authors.initials: D
authors.lastname: Meier
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
mesh_terms: D000068879:Adalimumab; D000714:Anastomosis, Surgical; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D013505:Digestive System Surgical Procedures; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000151:congenital* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000069285:Infliximab; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014456:Ulcer / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D000069285:Infliximab; D000068879:Adalimumab