What is the role of surgery in the treatment of colitis?

Updated: Jan 04, 2019
  • Author: David A Piccoli, MD; Chief Editor: Carmen Cuffari, MD  more...
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In patients with NEC, surgical intervention is required in 30-35% of babies. [31] Exploratory laparotomy with resection of bowel and external ostomy diversion is indicated if there is failure of medical management, erythema of the abdominal wall, a single fixed loop, a palpable mass, or evidence of perforation (eg, pneumoperitoneum or brown paracentesis). Central venous access is needed after bowel resection to permit total parenteral nutrition. Closely monitor the child for complications of short bowel syndrome and central catheters.

Surgery is indicated in patients with UC or CD if uncontrolled gastrointestinal (GI) bleeding, bowel perforation, bowel obstruction, failure to respond to medical therapy, and unacceptable medical toxicity are present. [32]

Total colectomy may be indicated to treat UC when the patient has toxic megacolon or acute fulminant colitis or in selected severe forms of the disease for which medical therapy (including rescue immunosuppressive agents such as infliximab) has failed. [33]

In UC, colectomy usually involves the creation of a pouch from the distal ileum and typically is curative (see Ulcerative Colitis). As many as 70% of the children develop at least one episode of so-called pouchitis (inflammation of the pouch) following proctocolectomy. [34] This entity is of unclear origin but typically responds quickly to a course of antimicrobial treatment. Evidence from studies of adults suggests that prophylaxis with probiotics may be an effective preventative tool. [35]

In CD, surgery is not curative, because recurrent disease at the site of surgery is common. Segmental bowel resection is the most common procedure for treating CD and usually involves the diseased terminal ileum and adjacent inflamed colon. Strictureplasty should be considered if there is stenosed bowel segment without active inflammation. At times, surgical resection is used to treat growth failure. Adult studies suggest a role for biologics in prevention of postoperative recurrence of the disease, particularly prevention of endoscopic recurrence of disease. [36, 37]

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