Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2015; 21(20): 6101-6116
Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6101
Surgical strategies in paediatric inflammatory bowel disease
Colin T Baillie, Jennifer A Smith
Colin T Baillie, Jennifer A Smith, Department of Paediatric Surgery, Royal Liverpool Childrens Hospital, NHS Trust, Liverpool L12 2AP, United Kingdom
Author contributions: All authors contributed to the manuscript.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Colin T Baillie, Consultant Paediatric Surgeon, Department of Paediatric Surgery, Royal Liverpool Childrens Hospital, NHS Trust, Eaton Rd, Liverpool L12 2AP, United Kingdom.
Telephone: +49-231-9144880 Fax: +49-231-91448888
Received: February 10, 2015
Peer-review started: February 10, 2015
First decision: March 10, 2015
Revised: March 30, 2015
Accepted: April 9, 2015
Article in press: April 9, 2015
Published online: May 28, 2015

Inflammatory bowel disease (IBD) comprises two distinct but related chronic relapsing inflammatory conditions affecting different parts of the gastrointestinal tract. Crohn’s disease is characterised by a patchy transmural inflammation affecting both small and large bowel segments with several distinct phenotypic presentations. Ulcerative colitis classically presents as mucosal inflammation of the rectosigmoid (distal colitis), variably extending in a contiguous manner more proximally through the colon but not beyond the caecum (pancolitis). This article highlights aspects of the presentation, diagnosis, and management of IBD that have relevance for paediatric practice with particular emphasis on surgical considerations. Since 25% of IBD cases present in childhood or teenage years, the unique considerations and challenges of paediatric management should be widely appreciated. Conversely, we argue that the organizational separation of the paediatric and adult healthcare worlds has often resulted in late adoption of new approaches particularly in paediatric surgical practice.

Keywords: Inflammatory bowel disease, Ulcerative colitis, Crohn's disease, Paediatric, Surgery

Core tip: Approximately 25% of patients with inflammatory bowel disease have onset of symptoms in childhood or adolescence. The unique and often severe features of childhood presentation make treatment decisions challenging. The dogma of surgical conservatism in Crohn's disease is challenged in the specific instance of left sided colitis. Furthermore we argue that the separation of adult and paediatric inflammatory bowel disease practice may disadvantage children, delaying adaption of innovative treatments and timely transition.