Abstract
Background: Temporary fecal diversion by means of an ileostomy or colostomy has been used in the surgical management of refractory colonic and perianal Crohn disease (CD). The aims of our study were to evaluate the outcomes after fecal diversion in pediatric patients with colonic and perianal CD. Methods: The records of patients who underwent fecal diversion for colonic and perianal CD at Children's Hospital of Wisconsin between July 2000 and June 2014 were reviewed retrospectively. Patient demographics, medication use, onset and extent of disease, response to fecal diversion, rate of stoma reversal and relapse rate after stoma reversal were recorded. Results: We identified 28 consecutive patients (20 females, 8 males; median age 13.9 years) undergoing fecal diversion for refractory colonic (n = 21) and perianal CD (n = 7). Median duration of follow-up after fecal diversion was 2.26 years (range, 0.79–10.2 years). The response to fecal diversion was sustained clinical remission in 13/28 (46%), temporary clinical remission in 10/28 (36%), no change in 5/28 (18%). Intestinal continuity was restored in 14/28 (50%) patients; however, 3 (21%) required permanent stoma after reconnection. Classification tree analysis identified that female patients without perianal CD had higher rates of stoma reversal (p = 0.008). Conclusions: Fecal diversion can induce remission in pediatric patients with refractory colonic and perianal CD. Restoration of intestinal continuity was achieved in about 39%. Female patients without perianal CD carried no risk of a permanent stoma. Level of evidence: Level III study.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 472-476 |
| Number of pages | 5 |
| Journal | Journal of Pediatric Surgery |
| Volume | 53 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2018 |
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Keywords
- Children
- Crohn disease
- Fecal diversion
ASJC Scopus subject areas
- Surgery
- Pediatrics, Perinatology, and Child Health
Cite this
Outcomes after fecal diversion for colonic and perianal Crohn disease in children. / Dharmaraj, Rajmohan; Nugent, Melodee; Simpson, Pippa; Arca, Marjorie; Gurram, Bhaskar; Werlin, Steven.
In: Journal of Pediatric Surgery, Vol. 53, No. 3, 01.03.2018, p. 472-476.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Outcomes after fecal diversion for colonic and perianal Crohn disease in children
AU - Dharmaraj, Rajmohan
AU - Nugent, Melodee
AU - Simpson, Pippa
AU - Arca, Marjorie
AU - Gurram, Bhaskar
AU - Werlin, Steven
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Background: Temporary fecal diversion by means of an ileostomy or colostomy has been used in the surgical management of refractory colonic and perianal Crohn disease (CD). The aims of our study were to evaluate the outcomes after fecal diversion in pediatric patients with colonic and perianal CD. Methods: The records of patients who underwent fecal diversion for colonic and perianal CD at Children's Hospital of Wisconsin between July 2000 and June 2014 were reviewed retrospectively. Patient demographics, medication use, onset and extent of disease, response to fecal diversion, rate of stoma reversal and relapse rate after stoma reversal were recorded. Results: We identified 28 consecutive patients (20 females, 8 males; median age 13.9 years) undergoing fecal diversion for refractory colonic (n = 21) and perianal CD (n = 7). Median duration of follow-up after fecal diversion was 2.26 years (range, 0.79–10.2 years). The response to fecal diversion was sustained clinical remission in 13/28 (46%), temporary clinical remission in 10/28 (36%), no change in 5/28 (18%). Intestinal continuity was restored in 14/28 (50%) patients; however, 3 (21%) required permanent stoma after reconnection. Classification tree analysis identified that female patients without perianal CD had higher rates of stoma reversal (p = 0.008). Conclusions: Fecal diversion can induce remission in pediatric patients with refractory colonic and perianal CD. Restoration of intestinal continuity was achieved in about 39%. Female patients without perianal CD carried no risk of a permanent stoma. Level of evidence: Level III study.
AB - Background: Temporary fecal diversion by means of an ileostomy or colostomy has been used in the surgical management of refractory colonic and perianal Crohn disease (CD). The aims of our study were to evaluate the outcomes after fecal diversion in pediatric patients with colonic and perianal CD. Methods: The records of patients who underwent fecal diversion for colonic and perianal CD at Children's Hospital of Wisconsin between July 2000 and June 2014 were reviewed retrospectively. Patient demographics, medication use, onset and extent of disease, response to fecal diversion, rate of stoma reversal and relapse rate after stoma reversal were recorded. Results: We identified 28 consecutive patients (20 females, 8 males; median age 13.9 years) undergoing fecal diversion for refractory colonic (n = 21) and perianal CD (n = 7). Median duration of follow-up after fecal diversion was 2.26 years (range, 0.79–10.2 years). The response to fecal diversion was sustained clinical remission in 13/28 (46%), temporary clinical remission in 10/28 (36%), no change in 5/28 (18%). Intestinal continuity was restored in 14/28 (50%) patients; however, 3 (21%) required permanent stoma after reconnection. Classification tree analysis identified that female patients without perianal CD had higher rates of stoma reversal (p = 0.008). Conclusions: Fecal diversion can induce remission in pediatric patients with refractory colonic and perianal CD. Restoration of intestinal continuity was achieved in about 39%. Female patients without perianal CD carried no risk of a permanent stoma. Level of evidence: Level III study.
KW - Children
KW - Crohn disease
KW - Fecal diversion
UR - http://www.scopus.com/inward/record.url?scp=85043423411&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85043423411&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2017.08.011
DO - 10.1016/j.jpedsurg.2017.08.011
M3 - Article
C2 - 28889960
AN - SCOPUS:85043423411
VL - 53
SP - 472
EP - 476
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 3
ER -