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[Pediatric Crohn's disease complications]
Insights
This case report details a successful combined treatment for a child with Crohn's disease and an abdominal abscess. The approach involved surgery and immunosuppression, preserving the small bowel and promoting healthy growth.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Crohn's disease in children can present with complex complications, including extensive intestinal involvement and abscess formation.
- Management of pediatric Crohn's disease requires tailored approaches to balance disease control with growth and development.
- Surgical intervention is often necessary for complications but must consider long-term bowel preservation.
Observation:
- A pediatric patient presented with Crohn's disease affecting the ileocecal and sigmoid regions, complicated by a severe abdominal wall abscess.
- An initial combined approach included intestinal diversion, abscess drainage, antibiotics, nutritional support, and azathioprine immunosuppression.
- Definitive treatment involved limited resection, multiple strictureplasties, fistula closure, and undiversion, followed by nutritional support and continued immunosuppression.
Findings:
- The combined therapeutic strategy effectively managed the acute episode and led to successful definitive treatment.
- Strictureplasty in this pediatric patient conserved small bowel length, avoiding extensive resection.
- At 18 months follow-up, the child exhibited normal growth, significant weight and height gain, and no recurrence of fistula or restenosis.
Implications:
- This case suggests that strictureplasty is a safe and effective technique for managing pediatric Crohn's disease strictures, preserving bowel length.
- A combined surgical and medical approach can lead to favorable long-term outcomes in complex pediatric Crohn's disease cases.
- Conserving small bowel in pediatric Crohn's disease is crucial for long-term nutritional status and overall growth and development.
Abstract:
This case report describes our experience in treatment of a child with Crohn's disease involvement of ileocecal and sigmoid regions complicated with a severe abdominal wall abscess. A combined therapeutic approach of the acute episode was based on intestinal diversion, abscess drainage, antibiotherapy, nutritional support and post-operative immunosuppression with azathioprine. The definitive treatment of the ileocolonic involvement occurred 6 months after the acute episode and consisted of limited resection, multiple strictureplasties, primar" closure of ileosigmod fistula and undiversion. This operative procedure was followed by a short period of total parenteral nutrition and progressive re-establishment ofenteric nutritional support and immunosuppression. At 18 months follow-up, under low dose azathioprine revealed, a normal growth with a 20 Kg weight gain and 10 cm height gain, no evidence of fistula recurrence or restenosis and suggests the safety of strictureplasty in paediatric patients as a way to conserve as much small bowel as possible.