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Ulcerative Colitis (General Pediatric Surgery of Abdomen)

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Pediatric Surgery

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Abstract

Pediatric ulcerative colitis (UC) is a disease of the developed world. In some parts of the Western World, its incidence is stable, but in Northern Europe it is still increasing. UC presentation and symptoms are similar to adult-onset disease, but the rate of extensive disease is much higher in children. Typical symptoms include bloody diarrhea and abdominal tenesmus. General symptoms and significant growth retardation may occur but are less common than in Crohn’s disease (CD). Extraintestinal symptoms in various organ systems occur in a significant percentage of patients. Prompt diagnostic workup is required in a symptomatic patient to establish correct diagnosis and to avoid medical problems associated with delayed diagnosis. The initial treatment is medical, and the aim is to achieve remission of symptoms. Although treatment may be started with 5-ASA preparations, most pediatric patients require high dose steroids to achieve remission. Corticosteroids will prove unsuccessful in approximately 30–40% of children who will require second-line medical therapy with infliximab, tacrolimus or cyclosporines, or colectomy. A colectomy is indicated in toxic megacolon or severe bleeding or in cases of refractory to optimal medical therapy. In principle, removal of the diseased colon and rectum cures ulcerative colon. Today, restorative proctocolectomy is the surgical treatment of choice. The outcomes of surgery in recalcitrant UC are generally satisfactory, and the quality of life of the operated patients is similar to healthy peers. This is despite a high incidence of early and late surgical complications and pouchitis.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland

    Risto J. Rintala

  2. Children’s Hospital, Helsinki University Central Hospital, Department of Pediatric Surgery, University of Helsinki, Helsinki, Finland

    Mikko P. Pakarinen & Antti Koivusalo

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  1. Risto J. Rintala
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  2. Mikko P. Pakarinen
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  3. Antti Koivusalo
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Correspondence to Risto J. Rintala .

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  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

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Rintala, R.J., Pakarinen, M.P., Koivusalo, A. (2020). Ulcerative Colitis (General Pediatric Surgery of Abdomen). In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_106-1

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  • DOI: https://doi.org/10.1007/978-3-642-38482-0_106-1

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