Total colectomy in severe Crohn's colitis in children: Is permanent ileostomy necessary?

Abstract

Background: The classic operation for medically refractory Crohn's pancolitis is colectomy with end ileostomy. Ileorectal anastomosis (IRA) in this setting has not been well studied in children. In this study, we review our experience and outcomes with IRA in children with severe Crohn's Disease (CD). Methods: A single-center retrospective study was performed by reviewing the patient charts between 2017 and 2022. Before colectomy, disease severity was assessed by poor response to biologic medication and corticosteroids, the presence of serious comorbidities and history of C. difficile infection (CDI). Proctoscopy was done before IRA, and rectal histopathology at the time of IRA was reviewed. Postoperative complications, time from colectomy to anastomosis, and number of bowel movements were recorded. Results: 6 patients with pancolitis underwent laparoscopic total colectomy with end ileostomy and subsequent IRA. All patients were refractory to biologics and/or steroids. 4 patients had history of CDI. Mean age at the time of surgery was 16 ± 1 years. Postoperative course was complicated by AKI in 1 patient, pancreatitis in 1 patient, and rectal bleeding in 2 patients. A mean 274±130 days elapsed between colectomy and IRA. There were no complications or recurrent flares after IRA over the mean 356 ± 227 days follow-up. Patients had a mean of 5 bowel movements/day after IRA. Conclusion: IRA should be considered after colectomy for medically refractory CD in selected patients. A larger prospective study is necessary before recommendation for IRA as standard treatment. Level of Evidence: N/A

Keywords

• Crohn's disease
• Pancolitis
• Total colectomy
• Ileorectal anastomosis