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Vulvovaginal Complaints as the First Manifestation of Crohn's Disease in Children: Case Report
Xiomara B Brioso1, Darnna Banks2, Emily Christison-Lagay3
1Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, Connecticut.
Insights
Pediatric Crohn's disease can manifest as gynecological issues like rectolabial fistulas. Early collaboration ensures prompt diagnosis and treatment for better outcomes in children.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Gynecology
- Inflammatory Bowel Disease Research
Background:
- Crohn's disease (CD) is a chronic inflammatory condition impacting the gastrointestinal tract.
- Gynecological structures can be involved in pediatric CD, with rectovaginal or rectovestibular manifestations often presenting as initial signs.
Observation:
- A 9-year-old premenarchal female presented with chronic constipation, poor growth, and persistent vulvovaginal discharge/irritation.
- Examination revealed a rectolabial fistula, leading to a diagnosis of Crohn's disease via colonoscopy.
Findings:
- The patient's rectolabial fistula, a gynecological manifestation, was indicative of underlying Crohn's disease.
- Immunotherapy led to symptom improvement and positive anatomical changes in the affected child.
Implications:
- Persistent vulvar complaints in children necessitate considering non-gynecological diagnoses, including Crohn's disease.
- Multidisciplinary collaboration among pediatric gynecologists, gastroenterologists, and surgeons is crucial for timely diagnosis and management of genital Crohn's disease.
Background:
Crohn's disease, a chronic gastrointestinal inflammatory condition, can involve gynecological structures. Rectovaginal or rectovestibular involvement may be the first sign in the pediatric population and may result in delayed diagnosis and treatment.
Case:
A 9-year-old premenarchal female with chronic constipation and poor growth presented to the pediatric gynecologist for evaluation of persistent vulvovaginal discharge and vulvar irritation. Examination under anesthesia revealed a rectolabial fistula; colonoscopy was diagnostic of Crohn's disease. Immunotherapy resulted in improvement of symptoms and anatomical changes.
Summary And Conclusion:
In cases of persistent vulvar complaints in a child without clear diagnosis, a high index of suspicion for a non-gynecologic diagnosis is necessary. Collaboration between pediatric gynecologists, gastroenterologists, and surgeons can result in prompt diagnosis and treatment of genital Crohn's disease.
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