This study is a retrospective review of eight pediatric patients with multifocal intestinal
Crohn's disease who underwent strictureplasty with or without concomitant bowel resection between January 1978 and April 1992. The patients ranged in age from 9.9 years to 18.5 years. Indications for surgery were partial
intestinal obstruction (n = 6), failure of medial
therapy or
steroid dependence (n = 4), growth failure (n = 2), and
enterocutaneous fistula (n = 2). Thirty-six strictureplasties were performed in the eight patients (median, 4.5 strictureplasties per patient; range, 1-12). Bowel resection was performed in six of the eight patients in areas where strictureplasty was not feasible. The mean length of resection was 40 cm (range, 15-82 cm). The only complication was intestinal
hemorrhage, which was conservatively managed in two patients. The patients were followed for a mean of 19 months (range, 3-55 months). Five patients had a weight below the fifth percentile prior to surgery. Postoperatively, there was a
weight gain in seven patients, including all five patients who were originally below the fifth percentile. A statistically significant
weight gain was found when a paired t test analysis was applied to the entire group (p = 0.04). Five of six patients who were on
steroid medication at the time of surgery were successfully weaned within 1.5-3 months (mean, 2.3 months) from the time of surgery. Seven of eight patients had relief of their intestinal symptoms. Strictureplasty with small-bowel resection, or perhaps strictureplasty alone, in pediatric patients with multifocal intestinal
Crohn's disease can improve gastrointestinal symptoms, promote
weight gain, and allow discontinuation of
steroid medications.(ABSTRACT TRUNCATED AT 250 WORDS)