Abstract
Aim The onset of inflammatory bowel disease (IBD) in patients younger than the age of
5 years is rare. Moreover, when there is exclusive colonic inflammation, diagnosis
can be challenging. Our aim was to describe the difficulties and pitfalls in the diagnosis
of early-onset IBD (eoIBD) and their repercussions in treatment decisions.
Patients and Methods Patients with eoIBD (Crohn's disease [CD], ulcerative, and unclassified colitis)
treated at our center between 1990 and 2016 were studied retrospectively. Demographic,
clinical, medical, and surgical treatment data were analyzed.
Results A total of 19 patients were diagnosed with eoIBD at 21 (1–46) months of age. Bloody
diarrhea, growth failure, and abdominal pain were present in 90, 42, and 16%, respectively.
After 9 (1–62) months from the onset, patients were classified as ulcerative colitis
(nine), CD (two), and unclassified colitis (eight). Unresponsiveness to medical treatment
was observed in 10 and prompted surgical assessment. A partial colectomy was performed
in one, and nine underwent a total colectomy (one end stoma and eight ileoanal anastomosis
[IAA]). At least one surgical complication occurred in 80% and ultimately six patients
with an IAA required an end stoma. Overtime, final diagnosis of 5 out of the 10 surgical
patients changed due to biopsy findings, unresponsiveness to medical treatment, or
extraintestinal and perianal manifestations. After a 12-year (1–22) follow-up, 57.9%
of the diagnoses of all patients were modified.
Conclusion EoIBD poses a challenge due to ambiguous presentation and absence of specific diagnostic
tests. Surgical evaluation is often needed and surgeons must be mindful of possible
initial misdiagnosis, in addition to short- and long-term outcomes before deciding
aggressive surgical measures as well as intestinal reconstruction.
Keywords
inflammatory bowel disease - early onset - surgical assessment - ulcerative colitis
- Crohn's disease