Surgical intervention for neonatal and infantile-onset severe colonic Crohn's disease: report of three cases

We reviewed the experiences of surgical intervention for neonatal and infantile-onset refractory colonic Crohn's disease. All cases were male patients with medical therapy resistant colonic Crohn's disease and anal lesions. Their quality of life was extremely poor because of long fasting, steroid complications, growth and mental retardation, and severe anal pain. Surgery, such as subtotal colectomy and/or ileostomy construction, induced remission and allowed these patients to wean off steroids administered generally. Pediatric Crohn's Disease Activity Index scores of all patients were significantly decreased. Reversible steroid complications disappeared after operation. Anal ulcers and multiple perianal fistulas were improved and the patients never complained of anal pain. All patients were able to achieve catch-up growth. Parents of all patients are satisfied with a physical or social development of their child after operation. However, mental retardation and eating disorders still remained in two patients. Early induction of surgical therapy may present a better outcome and improve quality of life for medical therapy-resistant cases in neonatal and infantile severe colonic Crohn's disease.