Etiologic and clinical analysis of chronic complex anal and rectal inflammation in children less than 3 years old
Yanlei Huang1, Shan Zheng1, Xianmin Xiao1
1Department of Pediatric Surgery, Children's Hospital of Fudan University Shanghai 201102, P.R. China.
Insights
Chronic complex anal and rectal inflammation in young children may indicate Crohn's disease or intestinal tuberculosis. Diagnosis involves clinical evaluation, auxiliary tests, and sometimes empirical drug treatment, avoiding unnecessary surgery.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Medicine
Background:
- Chronic complex anal and rectal inflammation presents diagnostic challenges in children under three.
- Early and accurate diagnosis is crucial for effective management and preventing long-term complications.
Purpose of the Study:
- To analyze the causes and clinical diagnostic methods for chronic complex anal and rectal inflammation in children under three years old.
- To evaluate the efficacy of diagnostic approaches and treatment strategies.
Main Methods:
- Retrospective analysis of seven pediatric patients (under 3 years) with chronic complex anal and rectal inflammation.
- Inclusion of clinical history, auxiliary examination results, and empirical treatment data for etiologic diagnosis.
Main Results:
- Crohn's disease (4 patients) and intestinal tuberculosis (1 patient) were confirmed diagnoses; 2 patients had suspected Crohn's disease.
- Common findings included anemia, low pre-albumin, elevated IgG/IgA levels. Colonoscopies showed varying degrees of colonic involvement.
- Diagnosis was confirmed via colonoscopy with histopathology or empirical drug treatment.
Conclusions:
- Consider Crohn's disease or intestinal tuberculosis in diagnosing chronic anal/rectal inflammation in young children.
- Local surgery may not always be necessary; empirical drug treatment can be beneficial.
- Further research into optimal diagnostic pathways for this pediatric population is warranted.
Objective:
To analyze the etiology and clinical diagnostic method for chronic complex anal and rectal inflammation in children less than 3 years old.
Method:
Seven children (5 males and 2 females; 1 year 8 months to 3 years of age at the time of physician evaluation) with chronic complex anal and rectal inflammation were enrolled between May 2008 and May 2013 at our hospital. Clinical history, results of auxiliary examinations, and empirical treatment of the children were analyzed retrospectively combined with the etiologic diagnosis.
Results:
Four patients were confirmed to have Crohn's disease and one patient was confirmed to have intestinal tuberculosis; two patients were suspected to have Crohn's disease. Anemia and low pre-albumin level were common (seven patients); serologic testing revealed four patients with elevated IgG levels and seven patients with elevated IgA levels; there were no patients with positive tuberculosis antibody titers and two patients were weakly positive for C-ANCA (one patient with Crohn's disease and one patient intestinal tuberculosis). Colonoscopies revealed that the entire colon was affected in one patient, the left hemicolon was affected in four patients, and the sigmoid colon and rectum were affected in two patients. Two patients with Crohn's disease and one patient with intestinal tuberculosis were diagnosed by colonoscopies in combination with histopathologic examinations. Two patients with Crohn's disease were confirmed after empirical drug treatment, and two other patients were not definitely diagnosed.
Conclusion:
The possibility of Crohn's disease or intestinal tuberculosis should be considered in the clinical diagnosis of complex chronic anal and rectal inflammation in younger children. Local surgery is sometimes unnecessary. Empirical drug treatment should be used if necessary.
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