Colectomy in pediatric ulcerative colitis: A single center experience of indications, outcomes, and complications.

BACKGROUND/PURPOSE: There is a paucity of data on outcomes and complications of colectomy for pediatric ulcerative colitis (UC). This study reports the experience of a regional center for 18years. METHODS: Patients were identified from a prospective database and data obtained by note review. Median height/weight-SDS were calculated preoperatively and postoperatively. Data are expressed as median values (range). RESULTS: 220 patients with UC (diagnosed <17years) were identified, and 19 (9%) had undergone colectomy. Age at diagnosis was 11.6years (1.3-16.5), and 42% of patients were male. Time from diagnosis to surgery was 2.2years (0.1-13.1). All patients had failed maximal medical therapy. Fifteen patients had urgent scheduled operation, and 4 had emergency procedures, with 2 for (11%) acute-severe colitis (1 Clostridium difficile colitis) and 2 for acute-severe colitis with toxic dilatation. All initial procedures were subtotal-colectomy with ileostomy. Nine patients (47%) had early complications (during initial admission), 7 (37%) requiring reoperation. Six (32%) had late complications, with 5 requiring laparotomy. No patients had both early and late complications. Height-SDS was -0.27 before surgery and -0.23 (maximal follow-up). Weight-SDS was 0.32 and 0.05 (maximal follow-up). CONCLUSION: Approximately 1/11 children with UC required colectomy during childhood. Half of patients had acute complications, and 1/3 of patients required another operation during their first admission. 1/3 of patients developed late complications.

Do tongue ties affect breastfeeding?

This study assessed indications for and safety and outcome of simple division of tongue tie without an anesthetic. There were 215 infants younger than 3 months (mean 0-19 days) who had major problems breastfeeding, despite professional support. Symptoms, tongue tie details, safety of division, and complications were recorded. Feeding was assessed by the mothers immediately, at 24 hours, and 3 months after division. Prior to division, 88% had difficulty latching, 77% of mothers experienced nipple trauma, and 72% had a continuous feeding cycle. During division, 18% slept throughout; 60% cried more after division (mean 0-15 seconds). There were no significant complications. Within 24 hours, 80% were feeding better. Overall, 64% breastfed for at least 3 months (UK national average is 30%). Initial assessment, diagnosis, and help, followed by division and subsequent support by a qualified lactation consultant, might ensure that even more mothers and infants benefit from breastfeeding.

Total colonic aganglionosis: a 15-year single center experience.

PURPOSE: Total colonic aganglionosis (TCA) is a rare condition, which is challenging to manage. Outcome data are sparse. We aimed to review the demographics, treatment, and outcomes of TCA in our center. PATIENTS AND METHODS: A retrospective case note review of 15 years from a single center was undertaken. RESULTS: A total of nine patients (five male) were managed. Gestational age at birth was 39 weeks (range, 32.5-41 weeks). All patients were referred with distal intestinal obstruction at a median of day 2 (range, 1-6 days) of life. Two patients were managed with a long-term stoma. One died with persistent functional obstruction (despite a ganglionic stoma). Of the nine patients, seven patients underwent staged pull-through: three Soave, three Duhamel, and one Martin procedure with no short-term complications. All patients had at least one readmission with enterocolitis, diarrhea, or high stoma output. Further procedures were required in four of the seven patients. Only one child (older than 3 years) has achieved continence. Two children (both aged 8 years) requested reformation of a stoma to manage incontinence. CONCLUSION: In this series, we observed high morbidity and poor functional outcome, which should be anticipated in TCA. Patients with TCA have a high probability of requiring a long-term stoma and this should be considered as a management option.

Crohn's disease post-cardiac transplantation presenting with severe growth failure and delayed onset of puberty.

We report a 15 yr-old girl who 10 yr post-cardiac transplantation presented with severe growth failure and delayed onset of puberty. She was found to have pan-enteric Crohn's disease and has done remarkably well on principally nutritional therapy with a significant growth spurt and the onset of menarche. The development of bowel disease whilst on immunosuppression is rare and the literature is reviewed.