Rialon Kristy L, Crowley Eileen, Seemann Natashia M, Fahy Aodhnait S, Muise Aleixo, Langer Jacob C
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
J Pediatr Surg. 2018 May;53(5):964-967. doi: 10.1016/j.jpedsurg.2018.02.023. Epub 2018 Feb 8.
The timing of J-pouch surgery following colectomy for children with very early-onset colitis is controversial, with some advocating early reconstruction and others delaying reconstruction because of fear that the colitis may be owing to Crohn's disease (CD). We sought to determine the long-term incidence of CD in this population and whether there may be clinical features that predict the risk of CD.
Children with noninfectious colitis diagnosed prior to age 10, who underwent subtotal colectomy and ileostomy from 2000 to 2015, were reviewed.
Twenty-five children were identified. Median age at presentation was 5.4years. Four were initially diagnosed with CD (16%), 14 with ulcerative colitis (UC) (56%), and 7 with inflammatory bowel disease unclassified (IBD-U) (28%). Eight eventually had pouch surgery. Five of the children with an initial diagnosis of UC or IBD-U developed findings that changed the diagnosis to CD at a median age of 13.4 (range 10.3 to 16.7) years. None had any indicators of CD at the initial presentation.
Approximately one quarter of patients with very early-onset colitis originally diagnosed as UC or IBD-U had a reclassification in diagnosis to CD over time. J-pouch reconstruction should be delayed until adolescence in children with very early-onset colitis.
2C.
对于极早发性结肠炎患儿，结肠切除术后J袋手术的时机存在争议，一些人主张早期重建，而另一些人则因担心结肠炎可能是由克罗恩病（CD）引起而推迟重建。我们试图确定该人群中CD的长期发病率，以及是否可能存在预测CD风险的临床特征。
回顾2000年至2015年间接受次全结肠切除术和回肠造口术的10岁前诊断为非感染性结肠炎的儿童。
共确定25名儿童。就诊时的中位年龄为5.4岁。4名最初被诊断为CD（16%），14名被诊断为溃疡性结肠炎（UC）（56%），7名被诊断为未分类的炎症性肠病（IBD-U）（28%）。8名最终接受了袋手术。最初诊断为UC或IBD-U的儿童中有5名在中位年龄13.4岁（范围10.3至16.7岁）时出现了改变诊断为CD的表现。最初就诊时均无任何CD指标。
最初诊断为UC或IBD-U的极早发性结肠炎患者中，约四分之一随着时间的推移诊断重新分类为CD。对于极早发性结肠炎患儿，J袋重建应推迟至青春期。
2C。
