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Master Thesis

Évolution après colectomie subtotale au cours des maladies inflammatoires chroniques intestinales de l'enfant

Abstract : Evolution after subtotal colectomy during inflammatory bowel disease in chidren.
Background: IBD evolution is frequently more severe in children. During an acute severe colitis, when the medical treatment is not efficient, the colectomy has to be performed. The rectum should be conserved whether a Crohn disease could be suspected. However the differential diagnosis between CD and ulcerative colitis is difficult especially in young children because of the frequency of UC-like colitis of CD.
Aims: to determine the rectum evolution after a subtotal colectomy and to assess the probability to perform an iléorectal anastomosis.
Methods: we reported 10 children, between 1 and 18 years of age, after a subtotal colectomy with an ileostomy, between 2000 and 2013.
Results: The median age at diagnosis was 5,4 years. The median age at surgery was 8,4 years. After the surgery, 9 patients were weaned of parenteral nutrition and corticosteroid treatment. Immunosuppressive treatments were raised in 5 children and the period of intestinal derivation was prolonged (2 years). The intestinal continuity with an ileorectal anastomosis was restored in 5 patients but 3 children needed a protectomy. 4 patients have been reclassified as CD during the follow up.
Conclusion: After subtotal colectomy for acute severe colitis, the decision of rectum conservation should address by a multidisciplinary staff. The rectum protection needs a prolonged ileostomy and an intense immunosuppression but allows to perform an iléorectale anastomosis in 50% of cases.
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Master Thesis
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Sarah Bamberger. Évolution après colectomie subtotale au cours des maladies inflammatoires chroniques intestinales de l'enfant. Médecine humaine et pathologie. 2014. ⟨dumas-01168298⟩

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