Inflammatory Bowel Disease: Update Course 2014

Children presenting with Crohn's disease for the first time with a perianal or perirectal abscess often have non-colonic small intestinal disease.

MR enterography provides information about both the stricture anatomy and the chronicity of disease, helping determine whether a stricture is chronic and fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy.

For duodenal Crohn's strictures, endoscopic and fluoroscopic dilation combined with Remicade can successfully manage the stricture, making it more pliable and allowing weight gain.

Isolated terminal ileal Crohn's disease in teenagers behaves differently from perianal or diffuse Crohn's disease, with recurrence potentially delayed 10-15 years after resection, allowing symptom-free passage through puberty into adulthood.

For isolated terminal ileal Crohn's disease, resection may be considered earlier than biologic therapy because patients can have very long symptom-free intervals (10-15 years) before recurrence.

In Europe, ultrasound is generally advocated for basically everything, but in sophisticated pediatric radiology departments, MRI remains the standard diagnostic tool for chronic inflammatory bowel disease, though ultrasound use is increasing.

Patients with ulcerative colitis referred for surgery are often in horrible shape because GI doctors view surgery as failure and carry patients on medical therapy for so long that by the time surgeons see them, they are emaciated with low albumin, poor nutritional status, and have been on steroids and multiple other medications.

After subtotal colectomy with end ileostomy for severe ulcerative colitis, patients get better incredibly fast, faster than after the subsequent J-pouch operation, and often look their best when they have their stoma.

Ongoing rectal bleeding from the rectal stump after subtotal colectomy for ulcerative colitis can occur and may force earlier completion proctectomy than anticipated, though this can be managed with local therapy.

One problem with three-stage colectomy is that patients often gain 20-30 pounds between stage 1 and 2, making the subsequent operation harder.

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.