Surgical Treatment of Chronic Ulcerative Colitis in Children
WILLIAM M. MICHENER, M.D., M.S.(Pediat.)
Department of Pediatricsand
RUPERT B. TURNBULL, M.D.
Department of General Surgery
TREATMENT of the child with chronic ulcerative colitis continues to be a challenge to the pediatrician, the gastroenterologist, and the surgeon. The clinical course of this disease is variable and at times unpredictable despite adequate medical therapy. Increased awareness that this entity occurs in children has led to early diagnosis and consequently better medical management of the illness. The availability of steroid hormones for systemic and topical administration has greatly improved the effectiveness of treatment of the child severely ill with chronic ulcerative colitis.
The progress made in the medical management of this disease has been coupled also with significant improvement in the surgical treatment. Ileostomy and subtotal colectomy have been lifesaving in several of our patients, and our overall experience with these procedures in the patients with ulcerative colitis has been gratifying and encouraging. With the improvement in surgical technic, and the obvious improvement of the child after ileostomy and subtotal colectomy, the controversy as to whether it is the medical or the surgical therapy that prolongs these patients' lives assumes importance.
Indications for surgical intervention during the course of ulcerative colitis in a child are usually definite, only occasionally controversial. Definite indications include: imminent perforation (toxic megacolon), carcinoma of the colon, and repeated massive hemorrhages. A controversial indication is the history of recurrent disabling disease for five years in the adolescent child. Differences of opinion are reflected in the range of percentages of patients with colitis who have been operated on in various institutions. However, the percentages of . . .