ulcerative colitis in infancy, our surgical results

background/purpose: ulcerative colitis(uc)  is a chronic, idiopathic, destructive disorder of colon. the incidence of uc peaks in the age group of15 to 25,and only 1% are infantile. despite initial medical treatment, in refractory cases, colectomy is needed. there are few studies regard surgical results in infancy with uc. methods:in this retrospective study we reviewed infants with ulcerative colitis that consulted with us for surgery between 2009 and 2014. we measured age at onset, family history of inflammatory bowel disease, symptoms of onset, colonoscopic findings, duration of medical treatment, indication of surgery, type of operation, surgical complications and management of them, and rate of mortality. results: 5 patients (4 boys, 1girl) were identified. the mean age of onset of the disease was 35(range3-60) days. the mean age of patients at the time of surgical consult was7months.the disease began in 3 patients with watery diarrhea .one case (12month old) had positive family history of his sister with similar presentation that expired in 3 month. he had sever ftt with no response to medical treatment   as indication for surgery and underwent total proctocoletomy,  ileoanal anasthomosis and  loop ileostomy  but it failed and 3 days after first operation we performed end ileostomy.2 cases had colon perforation followed colonoscopy and one of them(4month girl)expired before laparotomy and the other(12 month boy)underwent  colostomy in septic shock. the fourth patient was 2 day old neonate with abdominal distention and intestinal obstruction that rectal biopsy showed agangliosis and underwent transanal pulthrough  procedure but after surgery had recurrent  watery diarrhea and investigation showed uc. the last case was 3 days neonate that underwent ileostomy,in initial surgery with suspicion to total colonic agangliosis and then underwent subtotal colectomy  at 2month old.at1.5 year old he referred to us with  toxic megacolon in remenant colon and underwent colostomy,and 3 month later underwent final surgery. conclusions:if a child presents with recurrent bloody or waterly diarrhea even in infancy, uc should be considered as a differential diagnosis. the pattern of the disease in infancy appears more rigorous. evidence-based management of uc presenting in infancy is incomplete but early surgical attempt can reduce catastrophic results.