Ten to fifteen per cent of ulcerative colitis victims are children or adolescents. Because etiology and pathogenesis are so poorly understood, the results of medical therapy are often unsatisfactory. A life-threatening complication or protracted semiinvalidism, may require consideration of surgical intervention. Because surgery almost always means colectomy and permanent ileostomy, operation is generally advised reluctantly by physicians and accepted with great difficulty by the patient and his family.
In adults with ulcerative colitis, the indications for operation include such major complications as exsanguinating hemorrhage and fulminating disease with toxic megacolon; colonic obstruction; colonic carcinoma; and "intractability"—best defined as disease that is so severe and resistant that the patient cannot follow a normal pattern of living. What are the indications for operation in children with colitis? Do these differ essentially from those generally accepted in treating colitis in adults?
In a review of this problem in the American Journal of Diseases