Faculty Collaboration Database

Outcomes after fecal diversion for colonic and perianal Crohn disease in children. J Pediatr Surg 2018 Mar;53(3):472-476

Date

09/12/2017

Pubmed ID

28889960

DOI

10.1016/j.jpedsurg.2017.08.011

Scopus ID

2-s2.0-85043423411 (requires institutional sign-in at Scopus site)   12 Citations

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 13.9years) undergoing fecal diversion for refractory colonic (n=21) and perianal CD (n=7). Median duration of follow-up after fecal diversion was 2.26years (range, 0.79-10.2years). 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.

Author List

Dharmaraj R, Nugent M, Simpson P, Arca M, Gurram B, Werlin S

Author

Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Colostomy
Crohn Disease
Female
Follow-Up Studies
Humans
Ileostomy
Male
Retrospective Studies
Treatment Outcome
Young Adult