Three-stage surgical treatment for colon lesions in children with Crohn's disease. Retrospective-prospective study

Background. Crohn's disease (CD) in children is characterized by a more severe and progressive course, with the development of a form that is not susceptible to drug therapy, and the development of surgical complications. Up to 50% of cases, inflammation is localized in the ileocecal region. Isolated inflammation of the colon is diagnosed in the smallest number of patients with Crohn's disease, in adults from 18.1 to 28.3%, in pediatric patients from 5.1 to 24.4%.

Aim. To substantiate the effectiveness of three-stage surgical treatment in children with colon lesions in CD.

Materials and methods. From 2018 to 2022, 75 children with complicated Crohn's disease underwent surgical interventions in the National Medical Research Center for Children's Health. A single-stage retrospective-prospective study of 7 (9.3%) children with isolated colon lesion was conducted. Four (57%) children – stenosis in the left colon; 3 (43%) children – continuously recurrent inflammation of the colon, not amenable to drug therapy. The effectiveness of staged surgical treatment was evaluated after 6, 12, 18, 24 months based on statistical analysis of clinical, endoscopic and laboratory activity of CD, changes in anthropometric indicators.

Results. In 4 children, the onset of remission was noted, and in 3 children, clinical activity was mild (p<0.05). The onset of endoscopic (p<0.05) and laboratory remission (p<0.05) was noted in all children. The assessment of the growth-to-age ratio also showed statistically significant positive dynamics, however, when assessing the ratio of body mass index to age, no statistically significant changes were detected (p=0.066).

Conclusion. Isolated colon lesion is the rarest phenotype in children with CD. The formation of colon stricture requires surgical treatment, but predicting the volume of surgical treatment at the preoperative stage is a difficult task. The chosen tactics of conducting surgical treatment in three stages, with the correction of drug therapy after disconnecting the colon from the digestive tract, allowed not only to avoid postoperative complications associated with the formation of an anastomosis on the affected intestinal wall, but also to achieve remission of the disease.