Abstract
Obstruction, abscesses, fistulae, treatment failure, and growth retardation are not always absolute indications for surgery in Crohn's disease. At the Children's Hospital of Eastern Ontario we have advocated earlier surgery since 1974. Forty-eight cases are reviewed, 28 surgical (17 ileocecocolic, 2 ileocolic with normal rectum, 3 colorectal, 1 jejunal, 5 perineal). Ileocecocolic resection with primary anastomosis produced remission for at least 3.2 years. Remission in colectomy with primary ileocolic anastomosis was at least 1 year. Ileostomy and colorectal resection produced remissions for at least 1.66 years. After jejunal resection remission was 1.58 years. Significant height and weight gains in over 80% of cases encourage earlier surgery. Adequate medical treatment has not often influenced the disease process. Surgery does not remove useful, medically restorable to normal bowel. Most postoperative cases required no medications and none jave required steroids. Permanent cure of anorectal disease alone was not achieved. Surgical mortality was 0%. The average hospital stay was 11.6 days. Postoperative fistulae occurred in 1 case and closed spontaneously. Mycobacterium tuberculosis was found in 2 resected specimens and in 1 human tubercle bacilli were cultured after 5 months. Both cases healed spontaneously, and both were otherwise undistinguishable from the other cases of Crohn's disease. Both were white, native-born Canadians. On examination of all the other resected specimens in our series, no acid-fast bacilli were seen.
Similar content being viewed by others
References
Addison NV (1983) Abdominal tuberculosis — a disease reviewed. Ann R Coll Surg Eng 65: 105–111
Berner J, Weinstraub WH, Wesley JR (1979) Crohn's disease in children and adolescents: is inadequate weight gain a valid indication for surgery? J Pediatr Surg 14: 325–328
Chiodini RJ, Van Kruiningen HJ, Thayer WR (1984) Possible role of mycobacteria in inflammatory bowel disease. I. An unclassified mycobacterial species isolated from one patient with Crohn's disease. Dig Dis Sci 29: 1073–1079
Crohn BB, Ginsburg L, Oppenheimer GD (1932) Regional ileitis. A pathologic and clinical entity. JAMA 99: 1323–1329
Ehsannulah M, Isaacs A, Filipe MI (1984) Tuberculosis presenting as inflammatory bowel disease. Dis Colon Rectum 27: 134–136
Gitnick G (1984) Is Crohn's disease a mycobacterial disease after all? Dig Dis Sci 29: 1086–1088
Golde DW (1968) Etiology of regional enteritis. Lancet 2: 144–145
Homer R, Grand RJ, Colodny AM (1977) Growth, course and prognosis after surgery for Crohn's disease in children and adolescents. Pediatrics 59: 717–725
Patterson DSP, Allen WM (1972) Chronic mycobacterial enteritis in ruminants as a model of Crohn's disease. Proc R Soc Med 65: 998–1001
Postuma R, Moroz SP (1985) Pediatric Crohn's disease. J Pediatr Surg 20: 478–482
Thayer WR Jr, Coutu JA, Chiodini RJ (1984) Possible role of mycobacteria in inflammatory bowel disease. II. Mycobacterial antibodies in Crohn's disease. Dig Dis Sci 29: 1080–1085
Author information
Authors and Affiliations
Additional information
Offprint requests to: S. Mercer
Rights and permissions
About this article
Cite this article
Mercer, S., Soucy, P. Surgery for Crohn's disease in 28 children with the presence of acid-fast bacilli. Pediatr Surg Int 4, 39–42 (1988). https://doi.org/10.1007/BF00173082
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00173082