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DOI: 10.1055/s-0037-1609022
Pediatric Crohn's Disease
Publikationsverlauf
Publikationsdatum:
25. Februar 2018 (online)
Abstract
The incidence of Crohn's disease in the pediatric population is increasing. While pediatric patients with Crohn's disease exhibit many of the characteristics of older patients, there are important differences in the clinical presentation and course of disease that can impact the clinical decisions made during treatment. The majority of children are diagnosed in the early teen years, but subgroups of very early onset and infantile Crohn's present much earlier and have a unique clinical course. Treatment paradigms follow the traditional laddered approach, but growth and development represent special considerations that must be given to pediatric-specific complications of the treatment and disease. Surgical intervention is an important component of Crohn's management and is often employed to allow improved nutritional intake or decrease reliance on medical treatments that compromise growth.
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References
- 1 Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 2011; 17 (01) 423-439
- 2 Kappelman MD, Rifas-Shiman SL, Kleinman K. , et al. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol 2007; 5 (12) 1424-1429
- 3 Debruyn JC, Soon IS, Hubbard J, Wrobel I, Panaccione R, Kaplan GG. Nationwide temporal trends in incidence of hospitalization and surgical intestinal resection in pediatric inflammatory bowel diseases in the United States from 1997 to 2009. Inflamm Bowel Dis 2013; 19 (11) 2423-2432
- 4 Snapper SB. Very-early-onset inflammatory bowel disease. Gastroenterol Hepatol (N Y) 2015; 11 (08) 554-556
- 5 Pigneur B, Seksik P, Viola S. , et al. Natural history of Crohn's disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis 2010; 16 (06) 953-961
- 6 Gupta N, Bostrom AG, Kirschner BS. , et al. Presentation and disease course in early-compared to later-onset pediatric Crohn's disease. Am J Gastroenterol 2008; 103 (08) 2092-2098
- 7 DeBoer MD, Denson LA. Delays in puberty, growth, and accrual of bone mineral density in pediatric Crohn's disease: despite temporal changes in disease severity, the need for monitoring remains. J Pediatr 2013; 163 (01) 17-22
- 8 Tillack C, Seiderer J, Brand S. , et al. Correlation of magnetic resonance enteroclysis (MRE) and wireless capsule endoscopy (CE) in the diagnosis of small bowel lesions in Crohn's disease. Inflamm Bowel Dis 2008; 14 (09) 1219-1228
- 9 Siddiki HA, Fidler JL, Fletcher JG. , et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease. AJR Am J Roentgenol 2009; 193 (01) 113-121
- 10 de Bie CI, Paerregaard A, Kolacek S. , et al; EUROKIDS Porto IBD Working Group of ESPGHAN. Disease phenotype at diagnosis in pediatric Crohn's disease: 5-year analyses of the EUROKIDS Registry. Inflamm Bowel Dis 2013; 19 (02) 378-385
- 11 Escher JC. Mucosal healing in pediatric Crohn's disease: Pro/Con balance. Inflamm Bowel Dis 2004; 10 (04) 484
- 12 Bousvaros A. Mucosal healing in children with Crohn's disease: appropriate therapeutic goal or medical overkill?. Inflamm Bowel Dis 2004; 10 (04) 481-483
- 13 Ruemmele FM, Veres G, Kolho KL. , et al; European Crohn's and Colitis Organisation; European Society of Pediatric Gastroenterology, Hepatology and Nutrition. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohn's Colitis 2014; 8 (10) 1179-1207
- 14 Gupta K, Noble A, Kachelries KE. , et al. A novel enteral nutrition protocol for the treatment of pediatric Crohn's disease. Inflamm Bowel Dis 2013; 19 (07) 1374-1378
- 15 Markowitz J, Grancher K, Kohn N, Lesser M, Daum F. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease. Gastroenterology 2000; 119 (04) 895-902
- 16 Alfadhli AA, McDonald JW, Feagan BG. Methotrexate for induction of remission in refractory Crohn's disease. Cochrane Database Syst Rev 2005; (01) CD003459
- 17 Hyams J, Crandall W, Kugathasan S. , et al; REACH Study Group. Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn's disease in children. Gastroenterology 2007; 132 (03) 863-873 , quiz 1165–1166
- 18 Ferrari L, Krane MK, Fichera A. Inflammatory bowel disease surgery in the biologic era. World J Gastrointest Surg 2016; 8 (05) 363-370
- 19 Abbas PI, Peterson ML, Fallon SC. , et al. Evaluating the impact of infliximab use on surgical outcomes in pediatric Crohn's disease. J Pediatr Surg 2016; 51 (05) 786-789
- 20 Alsaleh A, Gaidos JK, Kang L, Kuemmerle JF. Timing of last preoperative dose of infliximab does not increase postoperative complications in inflammatory bowel disease patients. Dig Dis Sci 2016; 61 (09) 2602-2607
- 21 Lau C, Dubinsky M, Melmed G. , et al. The impact of preoperative serum anti-TNFα therapy levels on early postoperative outcomes in inflammatory bowel disease surgery. Ann Surg 2015; 261 (03) 487-496
- 22 Griffiths AM, Alemayehu E, Sherman P. Clinical features of gastroduodenal Crohn disease in adolescents. J Pediatr Gastroenterol Nutr 1989; 86: 259-262
- 23 Dziki A, Galbfach P. Crohn's disease--when to operate?. Acta Chir Iugosl 2004; 51 (02) 61-68
- 24 McLeod RS. Surgery for inflammatory bowel diseases. Dig Dis 2003; 21 (02) 168-179
- 25 Veroux M, Angriman I, Ruffolo C. , et al. Severe gastrointestinal bleeding in Crohn's disease. Ann Ital Chir 2003; 74 (02) 213-215 , discussion 216
- 26 Andersson P, Olaison G, Bodemar G, Nyström PO, Sjödahl R. Surgery for Crohn colitis over a twenty-eight-year period: fewer stomas and the replacement of total colectomy by segmental resection. Scand J Gastroenterol 2002; 37 (01) 68-73
- 27 Hurst RD, Molinari M, Chung TP, Rubin M, Michelassi F. Prospective study of the features, indications, and surgical treatment in 513 consecutive patients affected by Crohn's disease. Surgery 1997; 122 (04) 661-667 , discussion 667–668
- 28 Alvarez-Lobos M, Arostegui JI, Sans M. , et al. Crohn's disease patients carrying Nod2/CARD15 gene variants have an increased and early need for first surgery due to stricturing disease and higher rate of surgical recurrence. Ann Surg 2005; 242 (05) 693-700
- 29 Mazor Y, Maza I, Kaufman E. , et al. Prediction of disease complication occurrence in Crohn's disease using phenotype and genotype parameters at diagnosis. J Crohn's Colitis 2011; 5 (06) 592-597
- 30 Rufo PA, Bousvaros A. Current therapy of inflammatory bowel disease in children. Paediatr Drugs 2006; 8 (05) 279-302
- 31 Patel HI, Leichtner AM, Colodny AH, Shamberger RC. Surgery for Crohn's disease in infants and children. J Pediatr Surg 1997; 32 (07) 1063-1067 , discussion 1067–1068
- 32 Dokucu AI, Sarnacki S, Michel JL. , et al. Indications and results of surgery in patients with Crohn's disease with onset under 10 years of age: a series of 18 patients. Eur J Pediatr Surg 2002; 12 (03) 180-185
- 33 Konno M, Kobayashi A, Tomomasa T. , et al; Working Group of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition. Guidelines for the treatment of Crohn's disease in children. Pediatr Int 2006; 48 (03) 349-352
- 34 Heuschkel R, Salvestrini C, Beattie RM, Hildebrand H, Walters T, Griffiths A. Guidelines for the management of growth failure in childhood inflammatory bowel disease. Inflamm Bowel Dis 2008; 14 (06) 839-849
- 35 Andersson P, Olaison G, Hallböök O, Sjödahl R. Segmental resection or subtotal colectomy in Crohn's colitis?. Dis Colon Rectum 2002; 45 (01) 47-53
- 36 Martel P, Betton PO, Gallot D, Malafosse M. Crohn's colitis: experience with segmental resections; results in a series of 84 patients. J Am Coll Surg 2002; 194 (04) 448-453
- 37 Ruffolo C, Angriman I, Scarpa M. , et al. Urologic complications in Crohn's disease: suspicion criteria. Hepatogastroenterology 2006; 53 (69) 357-360
- 38 Solem CA, Loftus Jr EV, Tremaine WJ, Pemberton JH, Wolff BG, Sandborn WJ. Fistulas to the urinary system in Crohn's disease: clinical features and outcomes. Am J Gastroenterol 2002; 97 (09) 2300-2305
- 39 Present DH. Urinary tract fistulas in Crohn's disease: surgery versus medical therapy. Am J Gastroenterol 2002; 97 (09) 2165-2167
- 40 Gruner JS, Sehon JK, Johnson LW. Diagnosis and management of enterovesical fistulas in patients with Crohn's disease. Am Surg 2002; 68 (08) 714-719
- 41 Ben-Ami H, Ginesin Y, Behar DM, Fischer D, Edoute Y, Lavy A. Diagnosis and treatment of urinary tract complications in Crohn's disease: an experience over 15 years. Can J Gastroenterol 2002; 16 (04) 225-229
- 42 Akobeng AK, Suresh-Babu MV, Firth D, Miller V, Mir P, Thomas AG. Quality of life in children with Crohn's disease: a pilot study. J Pediatr Gastroenterol Nutr 1999; 28 (04) S37-S39
- 43 Berg DF, Bahadursingh AM, Kaminski DL, Longo WE. Acute surgical emergencies in inflammatory bowel disease. Am J Surg 2002; 184 (01) 45-51
- 44 Galandiuk S, Kimberling J, Al-Mishlab TG, Stromberg AJ. Perianal Crohn disease: predictors of need for permanent diversion. Ann Surg 2005; 241 (05) 796-801 , discussion 801–802
- 45 Ecker KW, Gierend M, Kreissler-Haag D, Feifel G. Reoperations at the ileostomy in Crohn's disease reflect inflammatory activity rather than surgical stoma complications alone. Int J Colorectal Dis 2001; 16 (02) 76-80
- 46 Froehlich F, Juillerat P, Mottet C. , et al. Obstructive fibrostenotic Crohn's disease. Digestion 2005; 71 (01) 29-30
- 47 Karaoglu AO, Yukselen V. Obstructing Crohn's disease of the duodenum: is surgery always mandatory?. Int J Clin Pract 2004; 58 (02) 221-223
- 48 Heimann TM, Greenstein AJ, Lewis B, Kaufman D, Heimann DM, Aufses Jr AH. Comparison of primary and reoperative surgery in patients with Crohns disease. Ann Surg 1998; 227 (04) 492-495
- 49 Glehen O, Lifante JC, Vignal J. , et al. Small bowel length in Crohn's disease. Int J Colorectal Dis 2003; 18 (05) 423-427
- 50 Yamamoto T, Bain IM, Mylonakis E, Allan RN, Keighley MR. Stapled functional end-to-end anastomosis versus sutured end-to-end anastomosis after ileocolonic resection in Crohn disease. Scand J Gastroenterol 1999; 34 (07) 708-713
- 51 Ikeuchi H, Kusunoki M, Yamamura T. Long-term results of stapled and hand-sewn anastomoses in patients with Crohn's disease. Dig Surg 2000; 17 (05) 493-496
- 52 Tersigni R, Alessandroni L, Barreca M, Piovanello P, Prantera C. Does stapled functional end-to-end anastomosis affect recurrence of Crohn's disease after ileocolonic resection?. Hepatogastroenterology 2003; 50 (53) 1422-1425
- 53 Yamamoto T. Factors affecting recurrence after surgery for Crohn's disease. World J Gastroenterol 2005; 11 (26) 3971-3979
- 54 Resegotti A, Astegiano M, Farina EC. , et al. Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn's disease surgery. Dis Colon Rectum 2005; 48 (03) 464-468
- 55 Larson DW, Pemberton JH. Current concepts and controversies in surgery for IBD. Gastroenterology 2004; 126 (06) 1611-1619
- 56 Muñoz-Juárez M, Yamamoto T, Wolff BG, Keighley MR. Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn's disease. Dis Colon Rectum 2001; 44 (01) 20-25 , discussion 25–26
- 57 Yamamoto T, Allan RN, Keighley MR. Strategy for surgical management of ileocolonic anastomotic recurrence in Crohn's disease. World J Surg 1999; 23 (10) 1055-1060 , discussion 1060–1061
- 58 Cunningham MF, Docherty NG, Coffey JC, Burke JP, O'Connell PR. Postsurgical recurrence of ileal Crohn's disease: an update on risk factors and intervention points to a central role for impaired host-microflora homeostasis. World J Surg 2010; 34 (07) 1615-1626
- 59 Scarpa M, Angriman I, Barollo M. , et al. Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease. Hepatogastroenterology 2004; 51 (58) 1053-1057
- 60 Yamamoto T, Keighley MR. Stapled functional end-to-end anastomosis in Crohn's disease. Surg Today 1999; 29 (07) 679-681
- 61 Galandiuk S. Stapled and hand-sewn anastomoses in Crohn's disease. Dig Surg 1998; 15 (06) 655
- 62 Hashemi M, Novell JR, Lewis AA. Side-to-side stapled anastomosis may delay recurrence in Crohn's disease. Dis Colon Rectum 1998; 41 (10) 1293-1296
- 63 Colombel JF, Loftus Jr EV, Tremaine WJ. , et al. Early postoperative complications are not increased in patients with Crohn's disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 2004; 99 (05) 878-883
- 64 Romeo E, Jasonni V, Caldaro T. , et al. Strictureplasty and intestinal resection: different options in complicated pediatric-onset Crohn disease. J Pediatr Surg 2012; 47 (05) 944-948
- 65 Dietz DW, Fazio VW, Laureti S. , et al. Strictureplasty in diffuse Crohn's jejunoileitis: safe and durable. Dis Colon Rectum 2002; 45 (06) 764-770
- 66 Laurent S, Detry O, Detroz B. , et al. Strictureplasty in Crohn's disease: short- and long-term follow-up. Acta Chir Belg 2002; 102 (04) 253-255
- 67 Dasari BV, Maxwell R, Gardiner KR. Assessment of complications following strictureplasty for small bowel Crohn's Disease. Ir J Med Sci 2010; 179 (02) 201-205
- 68 Hurst RD, Michelassi F. Strictureplasty for Crohn's disease: techniques and long-term results. World J Surg 1998; 22 (04) 359-363
- 69 Milsom JW, Hammerhofer KA, Böhm B, Marcello P, Elson P, Fazio VW. Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn's disease. Dis Colon Rectum 2001; 44 (01) 1-8 , discussion 8–9
- 70 Dutta S, Rothenberg SS, Chang J, Bealer J. Total intracorporeal laparoscopic resection of Crohn's disease. J Pediatr Surg 2003; 38 (05) 717-719
- 71 Tilney HS, Constantinides VA, Heriot AG. , et al. Comparison of laparoscopic and open ileocecal resection for Crohn's disease: a metaanalysis. Surg Endosc 2006; 20 (07) 1036-1044
- 72 Bonnard A, Fouquet V, Berrebi D. , et al. Crohn's disease in children. Preliminary experience with a laparoscopic approach. Eur J Pediatr Surg 2006; 16 (02) 90-93
- 73 Maartense S, Dunker MS, Slors JF. , et al. Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial. Ann Surg 2006; 243 (02) 143-149 , discussion 150–153
- 74 Casillas S, Delaney CP. Laparoscopic surgery for inflammatory bowel disease. Dig Surg 2005; 22 (03) 135-142
- 75 Hirayama I, Ide M, Shoji H. , et al. Laparoscopic-assisted partial ileectomy for crohn's disease associated with chronic anemia due to frequent hemorrhage. Hepatogastroenterology 2005; 52 (63) 823-825
- 76 Huilgol RL, Wright CM, Solomon MJ. Laparoscopic versus open ileocolic resection for Crohn's disease. J Laparoendosc Adv Surg Tech A 2004; 14 (02) 61-65
- 77 von Allmen D, Markowitz JE, York A, Mamula P, Shepanski M, Baldassano R. Laparoscopic-assisted bowel resection offers advantages over open surgery for treatment of segmental Crohn's disease in children. J Pediatr Surg 2003; 38 (06) 963-965
- 78 Shore G, Gonzalez QH, Bondora A, Vickers SM. Laparoscopic vs conventional ileocolectomy for primary Crohn disease. Arch Surg 2003; 138 (01) 76-79
- 79 Dasari BV, McKay D, Gardiner K. Laparoscopic versus open surgery for small bowel Crohn's disease. Cochrane Database Syst Rev 2011; (01) CD006956
- 80 Diamond IR, Gerstle JT, Kim PC, Langer JC. Outcomes after laparoscopic surgery in children with inflammatory bowel disease. Surg Endosc 2010; 24 (11) 2796-2802
- 81 Zaghiyan KN, Murrell Z, Fleshner PR. Scarless single-incision laparoscopic loop ileostomy: a novel technique. Dis Colon Rectum 2011; 54 (12) 1542-1546
- 82 Wu JS, Birnbaum EH, Kodner IJ, Fry RD, Read TE, Fleshman JW. Laparoscopic-assisted ileocolic resections in patients with Crohn's disease: are abscesses, phlegmons, or recurrent disease contraindications?. Surgery 1997; 122 (04) 682-688 , discussion 688–689
- 83 Milsom JW. Laparoscopic surgery in the treatment of Crohn's disease. Surg Clin North Am 2005; 85 (01) 25-34 , vii
- 84 Seymour NE, Kavic SM. Laparoscopic management of complex Crohn's disease. JSLS 2003; 7 (02) 117-121
- 85 Benoist S, Panis Y, Beaufour A, Bouhnik Y, Matuchansky C, Valleur P. Laparoscopic ileocecal resection in Crohn's disease: a case-matched comparison with open resection. Surg Endosc 2003; 17 (05) 814-818
- 86 Evans J, Poritz L, MacRae H. Influence of experience on laparoscopic ileocolic resection for Crohn's disease. Dis Colon Rectum 2002; 45 (12) 1595-1600
- 87 Watanabe M, Ohgami M, Teramoto T, Hibi T, Kitajima M. Laparoscopic ileocecal resection for Crohn's disease associated with intestinal stenosis and ileorectal fistula. Surg Today 1999; 29 (05) 446-448
- 88 Cima RR, Wolff BG. Reoperative Crohn's surgery: tricks of the trade. Clin Colon Rectal Surg 2007; 20 (04) 336-343
- 89 Uchikoshi F, Ito T, Nezu R. , et al. Advantages of laparoscope-assisted surgery for recurrent Crohn's disease. Surg Endosc 2004; 18 (11) 1675-1679
- 90 Hasegawa H, Watanabe M, Nishibori H, Okabayashi K, Hibi T, Kitajima M. Laparoscopic surgery for recurrent Crohn's disease. Br J Surg 2003; 90 (08) 970-973
- 91 Thaler K, Dinnewitzer A, Oberwalder M, Weiss EG, Nogueras JJ, Wexner SD. Assessment of long-term quality of life after laparoscopic and open surgery for Crohn's disease. Colorectal Dis 2005; 7 (04) 375-381
- 92 Duff S, Sagar PM, Rao M, Dolling S, Sprakes M, Hamlin PJ. Infliximab and surgical treatment of complex anal Crohn's disease. Colorectal Dis 2012; 14 (08) 972-976
- 93 Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB. ; American Gastroenterological Association Clinical Practice Committee. AGA technical review on perianal Crohn's disease. Gastroenterology 2003; 125 (05) 1508-1530
- 94 Judge TA, Lichtenstein GR. Treatment of fistulizing Crohn's disease. Gastroenterol Clin North Am 2004; 33 (02) 421-454 , xi–xii
- 95 Regueiro M, Mardini H. Treatment of perianal fistulizing Crohn's disease with infliximab alone or as an adjunct to exam under anesthesia with seton placement. Inflamm Bowel Dis 2003; 9 (02) 98-103
- 96 Topstad DR, Panaccione R, Heine JA, Johnson DR, MacLean AR, Buie WD. Combined seton placement, infliximab infusion, and maintenance immunosuppressives improve healing rate in fistulizing anorectal Crohn's disease: a single center experience. Dis Colon Rectum 2003; 46 (05) 577-583
- 97 Poritz LS, Rowe WA, Koltun WA. Remicade does not abolish the need for surgery in fistulizing Crohn's disease. Dis Colon Rectum 2002; 45 (06) 771-775
- 98 Lawal TA, Frischer JS, Falcone RA, Chatoorgoon K, Denson LA, Levitt MA. The transanal approach with laparoscopy or laparotomy for the treatment of rectal strictures in Crohn's disease. J Laparoendosc Adv Surg Tech A 2010; 20 (09) 791-795
- 99 Galandiuk S, Kimberling J, Al-Mishlab TG, Stromberg AJ. Perianal Crohn disease: predictors of need for permanent diversion. Ann Surg 2005; 241 (05) 796-801 , discussion 801–802
- 100 Regueiro M, El-Hachem S, Kip KE. , et al. Postoperative infliximab is not associated with an increase in adverse events in Crohn's disease. Dig Dis Sci 2011; 56 (12) 3610-3615
- 101 Bordeianou L, Stein SL, Ho VP. , et al. Immediate versus tailored prophylaxis to prevent symptomatic recurrences after surgery for ileocecal Crohn's disease?. Surgery 2011; 149 (01) 72-78
- 102 Spinelli A, Sacchi M, Fiorino G, Danese S, Montorsi M. Risk of postoperative recurrence and postoperative management of Crohn's disease. World J Gastroenterol 2011; 17 (27) 3213-3219 Review
- 103 Schwartz DA, Maltz BE. Treatment of fistulizing inflammatory bowel disease. Gastroenterol Clin North Am 2009; 38 (04) 595-610 Review
- 104 Rutgeerts P. Review article: recurrence of Crohn's disease after surgery - the need for treatment of new lesions. Aliment Pharmacol Ther 2006; 24 (Suppl. 03) 29-32
- 105 Yoshida K, Fukunaga K, Ikeuchi H. , et al. Scheduled infliximab monotherapy to prevent recurrence of Crohn's disease following ileocolic or ileal resection: a 3-year prospective randomized open trial. Inflamm Bowel Dis 2012; 18 (09) 1617-1623
- 106 Lémann M. Review article: can post-operative recurrence in Crohn's disease be prevented?. Aliment Pharmacol Ther 2006; 24 (Suppl. 03) 22-28
- 107 Sandborn WJ, Feagan BG. The efficacy of azathioprine and 6-mercaptopurine for the prevention of postoperative recurrence in patients with Crohn's disease remains uncertain. Gastroenterology 2004; 127 (03) 990-993
- 108 Rutgeerts P. Strategies in the prevention of post-operative recurrence in Crohn's disease. Best Pract Res Clin Gastroenterol 2003; 17 (01) 63-73
- 109 Pelletier AL, Stefanescu C, Vincent C, Etienney I, Mentré F, Soulé JC. Is the length of postoperative recurrence on the neo ileum terminal ileum predictable in Crohn's disease?. J Crohn's Colitis 2011; 5 (01) 24-27
- 110 Nissan A, Zamir O, Spira RM. , et al. A more liberal approach to the surgical treatment of Crohn's disease. Am J Surg 1997; 174 (03) 339-341
- 111 Blackburn SC, Wiskin AE, Barnes C. , et al. Surgery for children with Crohn's disease: indications, complications and outcome. Arch Dis Child 2014; 99 (05) 420-426