Surgical management of very early onset inflammatory bowel disease

Infographic · Jan 2026 · 2 min read

In brief

Retrospective study of 121 VEO-IBD patients found 22% required surgical intervention, most commonly ostomy creation. Black race, diagnosis before age one, severe disease, growth impairment, and perianal involvement significantly predicted need for surgery, while genetic findings and disease location did not.

Written by the GCMD Library team from the infographic.

A clinical decision flowchart with colored boxes and arrows showing treatment pathways. The layout flows from top to bottom with branching decision points. Blue boxes indicate diagnostic steps, green boxes show treatment options, and orange boxes highlight key decision criteria. Icons of a child patient and surgical instruments appear at the top.

Sarah J. Ullrich ∙ Annie Le-Nguyen ∙ Monica Holder ∙ Randi Wittenberg ∙ Allison Caja ∙ Aaron P. Garrison ∙ Beth A. Rymeski ∙ Nelson G. Rosen ∙ Jason S. Frischer

Purpose

The incidence of inflammatory bowel disease in children under six years of age, known as very early-onset inflammatory bowel disease (VEO-IBD) has been increasing. VEO-IBD has distinct clinical phenotypes, treatment response and outcomes, however the role of surgical intervention remains poorly understood. This study examines surgical management in this population.

Methods

We conducted a retrospective review of patients diagnosed with VEO-IBD at a single institution between January 2008 and May 2024. Data on demographics, clinical characteristics, and measures of disease severity were collected and analyzed using descriptive statistics.

Results

A total of 121 patients met criteria for inclusion. The majority of patients were diagnosed with a Crohn's disease phenotype (n = 74, 61.2 %). Disease was most frequently isolated to the colon (n = 76, 62.8 %) or ileocolic (n = 38, 31.4 %). Approximately half of the patients (n = 60, 49.6 %) had previously received treatment at another facility. Surgical intervention was required in 26 patients (21.5 %). Of those who had surgery, 69.2 % had an ostomy created, 34.6 % had a bowel resection, 26.9 % had an anorectal exam under anesthesia. Factors significantly associated with operative intervention included Black race (P = 0.011), diagnosis before one year of age (P = 0.022), height velocity ≤ 2SD (P = 0.005), perianal disease (0.005) and disease severity (P = 0.019). Notably, family history (P = 0.226), positive genetic findings (P = 0.459), disease classification (P = 0.991), and disease location were not significantly linked with the need for surgical intervention. Among children who had a bowel resection or stoma creation, there was no statistically significant difference in post-operative height velocity or medication usage.

Conclusion

This study represents the largest single-center review of surgical interventions in VEO-IBD patients, with a 22 % intervention rate. Black race, age at diagnosis, disease severity, decreased height velocity and presence of perianal disease significantly influence surgical need. Given the heterogeneity of VEO-IBD, further research is necessary to elucidate the role of surgery, as well as surgical outcomes in managing this complex condition.

The text in the image