Indications for the Surgical Treatment in Children and Adolescents With Complicated Crown Disease (Review of Literature)

Shcherbakova, O. V.; Razumovskiy, A. Yu.

doi:10.18821/1560-9510-2018-22-1-35-41

Cited by 4 publications

(1 citation statement)

References 54 publications

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“…Extent of surgery is defined by resection length and possibility of simultaneous forming of intestinal anastomosis or necessity of intestinal ostomy. The timing of gastrointestinal tract (GIT) continuity restoration is stable remission and opportunity for the next stage of surgical treatment [4,7,15].…”

Section: Introductionmentioning

confidence: 99%

Experience in the Surgical Management of Children with Complicated Crohn’s Disease

Bekin,

Dyakonova,

Gusev

et al. 2023

Preprint

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Crohn's disease (CD) is a chronic, immune-mediated inflammatory bowel disease characterized by transmural damage of various parts of the gastrointestinal tract. The aim of the study is to present our experience in pre-surgical diagnosis, selection of surgical tactics and volume of intervention in different variants of gastrointestinal tract lesions and disease activity. We undertook cross-sectional, retrospective-prospective study of 64 children who underwent surgery due to complicated CD. We analyzed CD activity via PCDAI, medications used, inflam-mation localization, and changes in mass-growth parameters at pre-surgery stage. Three patients from the group of 44 children with two-stage surgical treatment later showed inefficacy of GEBD in post-operative period. The disease progression was revealed and, therefore, subtotal colectomy was required. Three children had secondary adhesion of surgical wounds by means of active immunosuppressive therapy at preoperative period, and five patients developed suture sinuses at post-operative period. Early adhesive intestinal obstruction was revealed in 3 (4.7%) cases, and they required re-surgery. Personalized approach to the surgical treatment of children with complicated CD has shown its efficacy due to the small percentage of postoperative complications with re-surgery. There was significant improvement in mass-growth parameters, recovery of albumin levels, and anemia decrease in 96.9% of cases in the long-term postoperative period (6 months or more). Two children (3.1%) had the narrowing of anastomotic zone lumen, thus, without any obstruction. These cases were associated with violations in drug treatment

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Section: Introductionmentioning

confidence: 99%

Experience in the Surgical Management of Children with Complicated Crohn’s Disease

Bekin,

Dyakonova,

Gusev

et al. 2023

Preprint

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Three-stage surgical treatment for colon lesions in children with Crohn's disease. Retrospective-prospective study

Bekin

Dyakonova²,

Гусев³

et al. 2023

Pediatr. Con. Med.

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Background. Crohn's disease (CD) in children is characterized by a more severe and progressive course, with the development of a form that is not susceptible to drug therapy, and the development of surgical complications. Up to 50% of cases, inflammation is localized in the ileocecal region. Isolated inflammation of the colon is diagnosed in the smallest number of patients with Crohn's disease, in adults from 18.1 to 28.3%, in pediatric patients from 5.1 to 24.4%. Aim. To substantiate the effectiveness of three-stage surgical treatment in children with colon lesions in CD. Materials and methods. From 2018 to 2022, 75 children with complicated Crohn's disease underwent surgical interventions in the National Medical Research Center for Children's Health. A single-stage retrospective-prospective study of 7 (9.3%) children with isolated colon lesion was conducted. Four (57%) children stenosis in the left colon; 3 (43%) children continuously recurrent inflammation of the colon, not amenable to drug therapy. The effectiveness of staged surgical treatment was evaluated after 6, 12, 18, 24 months based on statistical analysis of clinical, endoscopic and laboratory activity of CD, changes in anthropometric indicators. Results. In 4 children, the onset of remission was noted, and in 3 children, clinical activity was mild (p0.05). The onset of endoscopic (p0.05) and laboratory remission (p0.05) was noted in all children. The assessment of the growth-to-age ratio also showed statistically significant positive dynamics, however, when assessing the ratio of body mass index to age, no statistically significant changes were detected (p=0.066). Conclusion. Isolated colon lesion is the rarest phenotype in children with CD. The formation of colon stricture requires surgical treatment, but predicting the volume of surgical treatment at the preoperative stage is a difficult task. The chosen tactics of conducting surgical treatment in three stages, with the correction of drug therapy after disconnecting the colon from the digestive tract, allowed not only to avoid postoperative complications associated with the formation of an anastomosis on the affected intestinal wall, but also to achieve remission of the disease.

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Predictors of surgical intervention in the onset of stenotic Crohn’s disease in a 15-year-old teenager

Yablokova

Хавкин²,

Лохматов

et al. 2022

jour

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Aim: to demonstrate a child with early ileocecal resection in stenosing Crohn’s disease, taking into account the risk factors of surgical intervention. Crohn’s disease (CD) is a chronic recurrent segmental granulomatous lesion of any part of the gastrointestinal tract, with a wide range of manifestations and various phenotypes of the disease. Despite the great diagnostic and therapeutic possibilities today, there is an increase in primary and secondary resistance to therapy, largely associated with an incorrect assessment of the CD phenotype, patient management strategy. In the above observation of CD in a teenager, clinical signs of ileocecal stenosis were observed 3 months after the supposed onset of the disease, which caused a planned laparoscopic ileocecal resection with the formation of a ileo-colon anastomosis. The start of CD in adolescence, positive ASCA-status are regarded as risk factors for surgical intervention in this child. Timely diagnosis did not allow to avoid surgery. It is necessary to make individual algorithms for the management of a child with CD, taking into account the predictors of surgical intervention, complications and unfavorable course of the disease already at the time of diagnosis.

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Indications for the Surgical Treatment in Children and Adolescents With Complicated Crown Disease (Review of Literature)

Cited by 4 publications

References 54 publications

Experience in the Surgical Management of Children with Complicated Crohn’s Disease

Experience in the Surgical Management of Children with Complicated Crohn’s Disease

Three-stage surgical treatment for colon lesions in children with Crohn's disease. Retrospective-prospective study

Predictors of surgical intervention in the onset of stenotic Crohn’s disease in a 15-year-old teenager

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