Background: The challenging treatment of penetrating paediatric Crohn’s disease (CD) involves pharmacological and surgical approaches [1−2]. Despite a proved efficacy of anti-TNF agents for treatment of complex fistula, a large number of patients cannot achieve a complete healing and relapses during the follow-up [3]. Specific aim: We report a paediatric case with CD and colonic perforation who was successfully treated with medical therapy only, including anti-TNFa. Case Report: During a colonoscopy performed on a 9 year old girl with CD, a perforation occurred in correspondence of the splenic flexure. A laparoscopic suture of the colonic wall was required. The formation of a peri-splenic and retro-colonic collection was then detected (US, enteric-CT), with concomitant appearance of fever and severe increase in the inflammation markers. Images also demonstrated a fistula connecting the colon to the collection. The girl was kept fasting and treated with total parenteral nutrition and antibiotic therapy. The dimensions of the collection decreased progressively at control images within two months. Treatment with infliximab was started according to the standard schedule, and after the third dose a US control showed disappearance of the collection and complete healing of the enteric fistula. Parenteral nutrition was progressively substituted with enteral feeding and no surgical treatments have been needed as yet. The girl is gaining weight and is maintaining good general conditions. Discussion: In pubertal children with CD, the option of an efficacious medical treatment to avoid a major surgical approach on the bowel (colectomy, ileostomy) is to be aimed for growth improvement. This approach requires a strictly monitored long-term follow-up. Reference(s) [1] Vermeire S, Van Assche G, Rutgeerts P. Review article: altering the natural histoty of Crohn’s disease − evidence for and against current therapies. Aliment Pharmacol Ther 2006; 25: 3−12. [2] Gupta N, Bostrom AG, Kirschner BS, Ferry GD, Gold BD, Cohen SA, Winter HS, Baldassano RN, Abramson O, Smith T, Heyman MB. Incidence of stricturing and penetrating complications of Crohn’s disease diagnosed in pediatric patients. Inflamm Bowel Dis 2010; 16(4): 638−44. [3] Gupta N, Cohen SA, Bostrom AG, Kirschner BS, Baldassano RN, Winter HS, Ferry GD, Smith T, Abramson O, Gold BD, Heyman MB. Risk factors for initial surgery in pediatric patients with Crohn’s disease. Gastroenterology 2006; 130(4): 1069−77.

Colonic perforation in a child with crohn’s disease: successful medical treatment can rescue from colectomy.

GUARISO, GRAZIELLA
2012

Abstract

Background: The challenging treatment of penetrating paediatric Crohn’s disease (CD) involves pharmacological and surgical approaches [1−2]. Despite a proved efficacy of anti-TNF agents for treatment of complex fistula, a large number of patients cannot achieve a complete healing and relapses during the follow-up [3]. Specific aim: We report a paediatric case with CD and colonic perforation who was successfully treated with medical therapy only, including anti-TNFa. Case Report: During a colonoscopy performed on a 9 year old girl with CD, a perforation occurred in correspondence of the splenic flexure. A laparoscopic suture of the colonic wall was required. The formation of a peri-splenic and retro-colonic collection was then detected (US, enteric-CT), with concomitant appearance of fever and severe increase in the inflammation markers. Images also demonstrated a fistula connecting the colon to the collection. The girl was kept fasting and treated with total parenteral nutrition and antibiotic therapy. The dimensions of the collection decreased progressively at control images within two months. Treatment with infliximab was started according to the standard schedule, and after the third dose a US control showed disappearance of the collection and complete healing of the enteric fistula. Parenteral nutrition was progressively substituted with enteral feeding and no surgical treatments have been needed as yet. The girl is gaining weight and is maintaining good general conditions. Discussion: In pubertal children with CD, the option of an efficacious medical treatment to avoid a major surgical approach on the bowel (colectomy, ileostomy) is to be aimed for growth improvement. This approach requires a strictly monitored long-term follow-up. Reference(s) [1] Vermeire S, Van Assche G, Rutgeerts P. Review article: altering the natural histoty of Crohn’s disease − evidence for and against current therapies. Aliment Pharmacol Ther 2006; 25: 3−12. [2] Gupta N, Bostrom AG, Kirschner BS, Ferry GD, Gold BD, Cohen SA, Winter HS, Baldassano RN, Abramson O, Smith T, Heyman MB. Incidence of stricturing and penetrating complications of Crohn’s disease diagnosed in pediatric patients. Inflamm Bowel Dis 2010; 16(4): 638−44. [3] Gupta N, Cohen SA, Bostrom AG, Kirschner BS, Baldassano RN, Winter HS, Ferry GD, Smith T, Abramson O, Gold BD, Heyman MB. Risk factors for initial surgery in pediatric patients with Crohn’s disease. Gastroenterology 2006; 130(4): 1069−77.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2574297
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