Surgical management of ulcerative colitis in childhood

Forty-seven children with ulcerative colitis (UC) have been treated by colectomy at the UCLA Hospital in the two decades since 1956. An intensive course of medical therapy including a short course of steroid treatment in an attempt to obtain clinical remission is recommended before proceeding with colectomy. Thirty-four children underwent elective colectomy, indicated by intractability of symptoms and a year of growth failure. Postoperative complication rates were higher after emergency colectomy (77 per cent) than after elective operation (50 per cent). The only deaths (3) occurred subsequent to emergency colectomy. Judicious use of preoperative steroids did not increase the incidence of postoperative complications. Thirteen of twenty-four children who underwent initial subtotal colectomy had the remaining rectum removed because of progression of disease within an average period of twenty-eight months. No child underwent successful ileorectal anastomosis after initial subtotal colectomy. Inasmuch as UC usually begins in the rectum, most children with this condition during the past ten years have been treated by total colectomy. Postoperative weight gain and improvement in quality of life were strikingly evident in almost all children who underwent total coloproctectomy. Colectomy is recommended particularly for children who do not experience remission from acute disease after steroid therapy and for those who have chronic disease during the growth period of adolescent years.