Ulcerative colitis in infancy: our results
Iranian Journal of Pediatric Surgery,
Vol. 2 No. 1 (2016),
23 August 2016
Introduction: Ulcerative colitis (UC) is a debilitating disorder of colon. The incidence of UC peaks in the age group of 15 to 25, and only 1% are infantile. Despite initial medical treatment, in refractory cases, colectomy is needed. There are few studies regarding surgical results of treatment of UC in infancy.
Material & Methods: In our descriptive retrospective study we reviewed medical files of infants with ulcerative colitis that consulted with us for surgery between 2009 and 2014. Age at onset, family history of inflammatory bowel disease, symptoms of onset, colonoscopic findings, duration of Medical treatment, Indication of surgery, Type of operation, surgical complications and their Management and mortality was recorded.
Results: We found five patients with the diagnosis of UC in their first year of life; 4 boys and 1girl. The mean age of onset of the disease was 35 days (range 3-60). The mean age of patients at the time of surgical consult was 7 months. The disease began in 3 patients with watery diarrhea. Family history was positive in only one of our cases. He had sever FTT with no response to medical treatment which was an indication for surgery and he underwent total proctocoletomy, ileoanal anastomosis and loop ileostomy which failed and 3 days after the first operation we performed an end ileostomy. Two cases had colon perforation following their colonoscopy and one of them (a 4 month girl) expired before laparotomy and the other (a 12 month boy) underwent colostomy creation while he was in septic shock. The fourth patient was a 2 day old neonate with abdominal distention and intestinal obstruction. Rectal biopsy showed agangliosis so he underwent a transanal pull through procedure with a diagnosis of hirschsprung’s disease. After surgery he experienced recurrent watery diarrhea and further diagnostic investigations brought about the diagnosis of UC. Our last patient was a 3 day old neonate that underwent ileostomy in the initial surgery with suspicion of total colonic agangliosis and underwent subtotal colectomy when he was 2 months old. At 1.5 years he developed toxic mega-colon in the remnant of colon when he was old and thus was referred to us and underwent colostomy. After 3 month the final surgery was carried out.
Conclusions: If a child presents with recurrent bloody or watery diarrhea even in infancy, UC should be considered as a differential diagnosis. The pattern of the disease in infancy appears more rigorous. Evidence-based management of UC presenting in infancy is incomplete but early surgical attempt can reduce catastrophic results.
- ulcerative colitis
- inflammatory bowel disease
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