Pediatric Surgery NaT is a comprehensive reference for the general surgical care of children. Contains learning objectives, images, videos, and links to MOC CME and the medical literature. Explore these free sample topics:
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Crohn disease (CD) is an idiopathic inflammatory autoimmune disease affecting the intestinal tract. Its distribution is variable but classically involves the ileum in some fashion. It is often grouped with ulcerative colitis (UC) under the umbrella of inflammatory bowel disease (IBD). Several key clinical and pathological findings distinguish CD from UC. CD can involve any segment of the intestinal tract from oral cavity to the anus and often may involve multiple discreet segments. UC on the other hand typically exclusively affects the colorectum and the classic transmural bowel inflammation of CD is not found in UC.
Despite significant improvements in medical management 75% of Crohn disease patients will require surgery.
How is pediatric different than adult Crohn disease?
Twenty percent of patients with CD are diagnosed before the age of twenty and CD has been reported as early as in infancy . The diagnosis of pediatric CD can be missed as symptoms are sometimes difficult to distinguish from common pediatric gastrointestinal conditions such as functional abdominal pain, gastroenteritis or celiac disease. Children with CD will often present with focal right sided abdominal pain that recurs along with some or all of the following: diarrhea, failure to thrive, growth failure, delayed puberty, pallor, unintentional weight loss, hematochezia, perianal pain, drainage or pruritus (from perianal skin tags, fistulae or abscesses) or a palpable abdominal mass.
Pediatric and adult CD share many clinical characteristics. A study of 891 children with CD found that abdominal pain (44%), diarrhea (39%) and weight loss (23%) were the most common presenting symptoms which is similar to adult data . In children less than six years old rectal bleeding was a more common presenting symptom (33%) and children afflicted with CD may present with more insidious symptoms such as growth failure and/or delayed puberty .
Pediatric CD has been shown to be a more complicated disease than in adults with a more aggressive disease course, increased disease extension and loss of response to medical treatment . Treatment options in children impact the potential on growth as well as pubertal and emotional development. These unique conditions in pediatric patients call for individualized strategies to achieve a balance between disease control and normal development.
see also Crohn Disease Procedures