Surgical treatment of ulcerative colitis in childhood.

As long as the aetiology ofulcerative colitis remains obscure, treatment of the disease must be confined to symptomatic relief measures. A wide variety of both medical and surgical methods of treatment have been tried over the years. During the past decade, our interest and expectations have been focused mainly on two principles of treatment, one medical and one surgical. The introduction of steroids in the treatment of ulcerative colitis brought about a wave of optimism among the medical profession. During the past few years, however, this optimism has proved unwarranted with regard to long-term results. The introduction of radical surgical procedures met with less enthusiasm, but has proved to offer considerably more than what is sacrificed. The value of radical surgery has been firmly established and the proportion of cases treated surgically is steadily increasing. The pathology and clinical manifestations of ulcerative colitis in children are essentially the same as in adults, with the whole range of well-known disease patterns, from the acute fulminating disaster, to the chronic remittent manifestations of the disease. The same extracolonic manifestations are found and the same complications from the bowel lesions occur: haemorrhage with anaemia, protein and fluid losses with electrolyte imbalance, necrotizing ulcerations with perforations and peritonitis, fibrosis with stricture formation, and malignant degeneration. In addition to these features many children show physical and emotional retardation from the detrimental effects of the disease upon the growing organism. The response to medical treatment may be temporarily promising, but long-term results are unsatisfactory with regard to mortality and morbidity rates. In a series of 137 cases from the medical department of our clinic, Lagercrantz (1955) reported a mortality rate of 14%, the most common cause of death being cancer of the colon; 54% of the cases were more or less disabled for shorter or longer periods of time, the remaining 32% stated that they