Worldwide, pediatric onset Crohn's Disease (CD) is increasingly common, with an estimated incidence as high as 15.3 per 100,000 and prevalence of 47.5 per 100,000 in some regions. 1 Up to 25% of patients with inflammatory bowel disease (IBD) are diagnosed younger than 18 years old, with the vast majority of these diagnosed in adolescence. 2,3 Children diagnosed with CD typically have more extensive disease, and one third of pediatric CD patients will require surgery within five years of diagnosis. 4, 5, 6 Presentation with an inflammatory phenotype is most common, with stricturing and penetrating phenotypes becoming increasingly prevalent later in the disease course. 6

Much like the adult population, with improvements in medical therapy for CD, surgical intervention for CD in the pediatric population is largely palliative, aiming to mitigate the consequences of complicated disease while preserving intestinal length. 7 It is especially pertinent for pediatric surgeons to consider additional relative indications for surgery in complicated CD including growth failure and mitigation of the long-term side effects of medical therapy. 8 Here, we aim to provide an overview of the surgical management of complicated CD, exclusive of perianal disease, for the pediatric surgeon.