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Crohn's Disease
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Pediatric surgery knowledge is growing exponentially, making it impossible to stay up to date — Todd Ponsky, Update Course Rewind: 2020 ERAS · 0:00
Update Course Rewind: 2020 ERAS
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Did you miss our annual virtual conference, the Update Course? Don't worry, we're highlighting our favorite presentations here. In this episode, Dr. Mary Brindle and Dr. Kurt Heiss discuss the importance of ERAS in the pediatric patient and
podcast11:54 · Feb 2021
Although there is evidence that early feeding in adult patients after intestinal surgery is beneficial, the authors didn't find any benefit in neonates — Mikko Pakarinen, Journal of Pediatric Surgery Article Review: September 2021 · 2:37
Journal of Pediatric Surgery Article Review: September 2021
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We're highlighting three articles from the September 2021 issue of the Journal of Pediatric Surgery. We review the articles with Dr. Mikko Pakarinen (JPS Editor for Europe), Dr. Todd Ponsky, and two of the authors from one of the articles (
podcast11:16 · Oct 2021
If a patient has received infliximab within the last 6 weeks before surgery, there is evidence (both adult and pediatric) that a three-stage procedure should probably be performed due to increased complication risk. — Corn, Inflammatory Bowel Disease: Update Course 2014 · 28:11
Inflammatory Bowel Disease (IBD) - Samir Pandya: Update Course 2014
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Dr. Samir Pandya presents case studies of Crohn's disease of ulcerative colitis.Discussion involved imaging modalities in Crohn's Disease, diagnosis of fibrostenotic and fistulizing Crohn's disease, endorectal advancement flap, permanent di
video28:36 · Nov 2018
Inflammatory Bowel Disease: Update Course 2015
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Dr. Samir Pandya,Assistant Professor, Department of Surgery, Children's and Women's Physicians of Westchester presents on inflammatory bowel disease. He discusses management of ulcerative colitis, indeterminate colitis, colectomy, and J-pou
video13:49 · Jan 2019
Inflammatory Bowel Disease: Update Course 2014
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Dr. Samir Pandya presents case studies of Crohn disease and ulcerative colitis. Discussion involves imaging modalities, diagnosis and management of fibrostenotic and fistulizing Crohn disease, endorectal advancement flap, permanent diversio
video28:36 · Jan 2019
Colorectal Quiz Episode 26: Perianal Crohn's Disease
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In this week's episode, Dr. Levitt and Dr. Frischer discuss perianal Crohn's disease with Dr. Lisa McMahon, director of the IBD center at Phoenix Children's Hospital and pediatric surgery fellow, Dr. Cristine Velazco.
We'll go over how to a
podcast23:58 · Jan 2022
Expert statements from the recordings in this collection.
Colorectal Quiz Episode 26: Perianal Crohn's Disease
In pediatric patients, unlike adult patients, the first presenting factor for Crohn's disease can often be perianal disease.
Jason Frischer9:29
Male gender over the age of 10, and presence of a fistula are risk factors with much higher incidence of Crohn's disease being diagnosed in patients presenting with perianal lesions to the emergency room.
Jason Frischer9:00
The mucosa heals first compared to skin in perianal disease, so leaving a mucosal opening without a seton risks recurrent abscess when biologics heal the mucosa.
Jason Frischer12:31
Making a large cruciate incision and packing a perianal abscess in a child with undiagnosed Crohn's disease may result in non-healing and potentially require colostomy or ileostomy.
Jason Frischer13:12
The highest risk factors for lymphoma with biologic therapy are male gender, teenage age, and combination therapy with methotrexate.
Jason Frischer6:52
Real risks of biologic agents include infectious complications such as tuberculosis and risk of lymphoma.
Cristine Velazco6:29
When the colonoscope cannot intubate the terminal ileum, capsule endoscopy or fecal calprotectin can be used to aid diagnosis.
Cristine Velazco3:47
If terminal ileum cannot be intubated, gastroenterologists may treat presumptively and re-scope after a few months of treatment when inflammation has decreased.
Jason Frischer4:36
Setons should remain in place for at least 6 months to allow the inflammatory tract to become non-inflammatory.
Lisa McMahon17:54
Before removing a seton, the bottom must look better, drainage must be better, the patient must be symptom-free, and they must have reached steady state of biologic (loading dose plus at least 3 more doses, typically 2-3 months from start).
Jason Frischer19:23
Inflammatory markers including fecal calprotectin, ESR, and CRP should be checked before removing a seton to ensure systemic disease is under control.
Jason Frischer19:55
The initial Remicade paper from 1998 or 1999 in the New England Journal of Medicine was on perianal disease and demonstrated improved healing time and improved length of time between recurrence when combination of seton and infliximab is used versus either separately.
Jason Frischer20:49
Remicade (infliximab) has the most literature on healing perianal disease; Humira also has good evidence but less literature; Stelara and vedolizumab are sometimes used with less information available.
Lisa McMahon20:27
Literature shows about a 10% response rate for perianal fistulas even without biologics if a seton is placed and removed, with much better outcomes with biologics.
Lisa McMahon19:12
Source control of infection must be achieved before starting immunosuppressive therapy including steroids and biologics.
Jason Frischer17:17
If an abscess is not adequately drained, reimaging should be performed before giving biologics or steroids.
Jason Frischer17:17
Hydrogen peroxide is preferred over methylene blue for identifying fistula tracts because it is neater; 3% hydrogen peroxide in a syringe with 16-20 gauge angiocath is used with a speculum in the anus.
Jason Frischer14:15
When a fistula opening cannot be found despite hydrogen peroxide testing, a seton should not be placed at that time to avoid creating a hole where there isn't one.
Jason Frischer14:54
For recurrent patients requiring repeat seton placement, repeat imaging should be obtained before seton removal.
Lisa McMahon18:45
It is common to have perianal disease in Crohn's; this patient had a delay in diagnosis and had perianal disease for quite some time with multiple skin tags and fissures.
Lisa McMahon7:24
Inflammatory Bowel Disease (IBD) - Samir Pandya: Update Course 2014
In a review study published recently, CT enterography is more accurate than MR enterography for Crohn's disease, though institutional radiologist expertise determines which modality performs better in practice.
Children presenting with Crohn's disease for the first time with a perianal or perirectal abscess often have non-colonic small intestinal disease.
Samir Pandya3:00
Contrast-enhanced ultrasound has sensitivity and specificity as high as 100% for Crohn's disease in previously undiagnosed patients, and above 95% in patients with known diagnosis, according to the Peloda study published in Pediatrics 2013.
Contrast-enhanced ultrasound is only available for clinical use in Europe at present and has not been approved by the FDA.
In Europe, ultrasound is the first-line imaging choice for Crohn's disease, followed by MR or CT enterography, whereas in the US, MR/CT enterography is first-line.
MR enterography provides information about the chronicity of Crohn's disease strictures, helping determine whether a stricture is chronic and fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy.
Perianal abscesses in Crohn's disease are unlikely to heal without fecal diversion because bowel continuity slows healing.
Modern TNF inhibitor drugs are effective at healing perianal disease in Crohn's, potentially allowing avoidance of fecal diversion in selected patients.
Samir Pandya11:00
Patients and parents would rather deal with a chronic perianal problem than manage a stoma.
Most Crohn's perianal abscesses are not single; when draining a perianal abscess in Crohn's disease, there are usually several fistulas present.
Samir Pandya13:00