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Peri-anal disease and IBD in Adolescence

Peri-anal disease and IBD in Adolescence. Bruce D George John Radcliffe Hospital Oxford. Control intestinal symptoms Optimise growth impaired at time of diagnosis in 88% Facilitate normal social development. Aims of Management of Crohn’s disease in adolescence. Emergency perforation

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Peri-anal disease and IBD in Adolescence

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  1. Peri-anal disease and IBD in Adolescence Bruce D George John Radcliffe Hospital Oxford

  2. Control intestinal symptoms Optimise growth impaired at time of diagnosis in 88% Facilitate normal social development Aims of Management of Crohn’s disease in adolescence

  3. Emergency perforation bleeding acute colitis Elective obstruction fistula chronic ill health/failure of medical therapy Indications for Surgery in Crohn’s disease

  4. Also delayed growth In adolescence

  5. Similar to adults: operate as soon as there is an indication play safe minimal resection But also: earlier surgery to facilitate growth and to avoid steroids Principles of surgery in adolescence

  6. Aggressive disease Early recurrence Psychological chronic ill health body image height, weight sexual development stoma Difficult problems

  7. Acute colitis Failure of medical therapy chronic disease recurrent acute attacks Dysplasia Impaired growth Indications for surgery in Ulcerative Colitis

  8. Overall fitness steroids, co-morbidity Colon certainty of diagnosis Psychology acceptability of stoma Sphincters manometry, U/S Nerves and tubes pelvic dissection Factors to consider

  9. Proctocolectomy and end ileostomy Proctocolectomy and ileal pouch reconstruction Colectomy and ileostomy (rectal stump) Colectomy and ileorectal anastomosis Surgical options in ulcerative colitis

  10. Consider colectomy and ileorectal in teens Completion proctectomy and pouch later UC in Adolescence

  11. Anal Crohn’s disease 20-80% of patients with Crohn’s get perianal disease Rectal > colonic > ileocaecal > small bowel Anal Crohn’s disease

  12. Primary Fissures Skin tags Ulcers Secondary Abscess/fistula Strictures Vaginal fistula (malignancy) Clinical features

  13. Benign fissures, tags Variable fistulae, strictures Aggressive cavitating ulcers, sepsis Variable natural history

  14. General Large bowel colonoscopy Small bowel small bowel enema Anus inspection EUA ultrasound, MRI Assessment of Anal Crohn’s disease

  15. Minimise symptoms Prevent complication sepsis incontinence unhealed wounds stenosis Aims of Treatment of Anal Crohn’s

  16. Do nothing Diet elemental, TPN Medical antibiotics, immunosuppressants, anti-TNF alpha Surgery drain sepsis, local procedures, distant resection, defunction, proctocolectomy Treatment Options

  17. Skin tags leave alone Haemorrhoids surgery contraindicated Fissures if painless leave alone if painful GTN, Botulinum Treatment of Specific Lesions

  18. Low Fistula may heal spontaneously if no rectal inflammation lay open

  19. High fistula unlikely to heal ensure sepsis drained anti-TNF alpha ?fibrin glue defunction proctocolectomy

  20. Anal Ulcers poor prognosis maximal medical therapy defunction proctocolectomy

  21. Thorough assessment Tailoring treatment to individual Symptom control Prevention of complications Accept defeat Summary of Anal Crohn’s Disease

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