Surgical management of Crohn's disease in children.

Crohn's disease is a chronic, transmural inflammatory disease of the intestinal tract most frequently involving the terminal ileum and colon. It is a disorder of undetermined etiology that shares many pathophysiologic clinical aspects with chronic ulcerative colitis. Surgical treatment of Crohn's disease continues to be generally limited to the treatment of the complications of the disease. It is being reported with increasing frequency in children of all ages. The surgical principle generally adhered to is to remove only enough intestine to relieve the complication but to maintain as much intestinal length as possible. Because of this requirement, strictureplasty has become a worthwhile surgical adjunct, especially when dealing with multiple minimally inflamed fibrotic strictures in the small intestine. It has been as beneficial in children as in adults. Restorative proctocolectomy and the Kock pouch procedure are discouraged in patients with known Crohn's disease because of numerous subsequent complications. It is very important that surgeons and physicians realize that although the disease process cannot be eradicated by surgery, the health and well-being of a child or teenager can be restored to normal for prolonged periods, if not permanently.