Outcomes after fecal diversion for colonic and perianal Crohn disease in children

Rajmohan Dharmaraj, Melodee Nugent, Pippa Simpson, Marjorie Arca, Bhaskar Gurram, Steven Werlin

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)472-476
Number of pages5
JournalJournal of Pediatric Surgery
Volume53
Issue number3
DOIs
StatePublished - Mar 1 2018

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Crohn Disease
Pediatrics
Ileostomy
Colostomy
Demography
Recurrence

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 journalArticle

Dharmaraj, Rajmohan ; Nugent, Melodee ; Simpson, Pippa ; Arca, Marjorie ; Gurram, Bhaskar ; Werlin, Steven. / Outcomes after fecal diversion for colonic and perianal Crohn disease in children. In: Journal of Pediatric Surgery. 2018 ; Vol. 53, No. 3. pp. 472-476.
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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.",
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