ABSTRACT
This had been the standard procedure for children with ulcerative colitis and multiple polyposis, but can also be utilized in severe Crohn colitis. The abdominal colectomy portion of the procedure may also be performed in conjunction with an endorectal pull-through. For patients with ulcerative colitis, initial medical management is generally advised. In children with an acute exacerbation of ulcerative colitis, surgery is indicated in cases of severe hemorrhage or in those who fail to respond to intensive medical treatment after several weeks. The timing of an elective procedure is more difficult to establish. Some surgeons feel that resection is only indicated in those
children who show mucosal atypia on colonoscopic biopsy. Detecting these changes is difficult because one cannot routinely biopsy the entire colon, and the incidence of carcinomatous changes increases as the duration of the disease increases. In fact, carcinoma can be found in many surgical specimens when only atypia was found on colonoscopic biopsy. Many surgeons therefore recommend a colectomy once the disease process has been present for ten years. However, today many gastroenterologists recommend surveillance colonoscopy every year or every other year even if the disease has been present for more than ten years. Surgery should be performed sooner if atypia is identified or in those children with significant growth failure or lack of sexual maturation, and in those on chronic high doses of steroids in whom significant changes and complications due to medication use have occurred. In children with multiple polyposis, the timing can also be controversial. If all the polyps can be removed from the colon and the child is followed up every six months, surgery can be delayed at least until the child is past adolescence. If the polyps are too numerous to be removed, surgery should be performed earlier.
