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SURGICAL TREATMENT OF ULCERATIVE COLITIS IN CHILDREN
Author(s) -
HAFFNER JON,
RØ JOHS. S.,
ALBRECHTSEN DAGFINN
Publication year - 1983
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.1983.tb09674.x
Subject(s) - medicine , ileostomy , proctitis , proctocolectomy , ulcerative colitis , anastomosis , rectum , surgery , colectomy , disease
. Twenty‐four children below the age of 16 were operated on for ulcerative colitis at Rikshospitalet during the 20‐year period 1960‐79. Fifteen were treated primarily with colectomy and ileo‐rectal anastomosis (IRA), nine with proctocolectomy and ileostomy (PCI). There were twice as many boys as girls in both groups, an equal age distribution (median 13 1/2 years for IRA, 14 1/2 for PCI), and identical median duration of disease (3 1/2 years). Twenty‐three of the 24 patients were below the expected weight and/or height for their age, 6 in each group were more than 2 SD. below. Six patients with IRA had been treated with steroids, compared with 5 with PCI. Six patients with IRA had normal rectal mucosa, 2 mild, five moderate and one severe proctitis. One had a rectal stricture. Two of the patients with IRA required immediate reoperation, and one subsequently died because of leakage at the anastomosis and septicaemia. One further patient, who required immediate proctectomy because of bleeding, also died of septicaemia. Six other IRA patients have required proctectomy later because of proctitis. One has died of rectal carcinoma. Five IRA patients are alive with intact rectum, but 2 require treatment for proctitis. None of the patients with PCI are dead, one has required an external revision of the ileostomy, otherwise the primary treatment has been completely successful. None have stomal, urinary or sexual dysfunction. It is concluded that colectomy with IRA gives poorer results than proctocolectomy with ileostomy in children, just as it does in adults. The results of PCI are so good that the present paediatric prejudice against surgical treatment seems quite unjustified.