COMPLEX TREATMENT OF PERINATAL CROHN’S DESEASE IN CHILDREN

Aim of the study – To improve the treatment tactics of perianal CK in children with the aim of improving the treatment results by using a multidisciplinary combined approach with the use of minimally invasive surgical techniques and conservative therapy. Materials and methods. The results of the diagnosis, treatment, and follow-up of 12 pediatric patients with perianal CK were analyzed. Complaints, anamnestic data were collected for all patients. Laboratory, physical and necessary instrumental examinations and morphologic study of samples of clinical material (tissues of removed fi stula ducts, polyps, rectal crypts, condylomas, etc.) were performed. The leukocyte index of intoxication (LII) and the hematological index of intoxication (HPI) were calculated for each of the studied group of hospitalized patients. The work uses generally accepted methods of statistical processing of medical and biological research data.The results. In the studied group, 66.7 % were boys, 33.3 % were girls. In 25 % of patients HC was diagnosed at the age of 2-12 years, in 75 % – at the age of 13-15 years. On hospitalization all patients had complaints and local symptoms characteristic for perianal HC of the corresponding localization, were in severe or moderate condition with signs of intoxication. 75 % of patients have a wide range of extraintestinal manifestations of CK. The mean values of LII and GPI indicators were 4.26 and 6.82, respectively. In all patients the presence of anemia, leukocytosis, increased ESR, level of C-reactive protein, fecal calprotectin, hypoalbuminemia, hyperglobulinemia (IgG), intestinal dysbiosis with Candida albicans colonization were determined. The necessary physical and instrumental examinations to determine the anatomy of the perianal lesions were performed under anesthesia. Drainage of open purulent foci and fi stulae was performed with permanent draining ligature, which was removed after 3-6 months in the absence of signs of infl ammation and determination ofhealing of the aff ected area. Determination and correction of specifi c and anti-relapse therapy for CK, anemia, laboratory- confirmed infl ammatory changes, dietary nutrition was carried out jointly with a gastroenterologist, a hematologist and an immunologist. A geneticist was consulted for all patients.Conclusions.1. The majority of cases of perianal HC in children occur during adolescence – 75 % of patients in the study group were 13-15 years old.2. The diagnostic search and treatment process of perianal HC in children requires a multidisciplinary approach with the participation of a gastroenterologist, a pediatric surgeon, a hematologist, a geneticist, an immunologist, a morphologist, etc. Supervision of the patient by the specifi ed specialists should be carried out both during inpatient and outpatient treatment with the aim of timely correction of the manifestations of HC.3. In the treatment of children with perianal CK, minimally invasive methods should be preferred to aggressive surgical interventions.4. Surgical treatment is appropriate in cases of complex high rectoperitoneal fi stulae when specifi c conservative treatment is ineff ective.5. The use of seton drains in the surgical treatment of perianal HC in children, in combination with pathogenetic conservative therapy, leads to healing of perianal lesions, shortening of hospital treatment terms and improvement of patients’ quality of life.