Clinical Cases of Crohn‘s Disease in Pediatric Hirschprung‘s Patients

Case Report

Austin J Gastroenterol. 2017; 4(1): 1077.

Clinical Cases of Crohn‘s Disease in Pediatric Hirschprung‘s Patients

Cerniauskaite R¹, Statkuviene J², Labanauskas L², Urbonas V³, Bagdzevicius S4, Adamonis K5, Rokaite R², Janciauskas D6 and Kucinskiene R²*

¹Department of Radiology, Vilnius University Hospital Santariskiu Clinics, Lithuania

²Department of Pediatric gastroenterology, Hospital of Lithuanian University of Health Sciences, Lithuania

³Department of Pediatric gastroenterology, Vilnius University Hospital Santariskiu Clinics, Lithuania

4Department of Pediatric surgery, Hospital of Lithuanian University of Health Sciences, Lithuania

5Department of Gastroenterology, Hospital of Lithuanian University of Health Sciences, Lithuania

6Department of Pathology, Hospital of Lithuanian University of Health Sciences, Lithuania

*Corresponding author: Kucinskiene R, Department of Pediatric Gastroenterology, Hospital of Lithuanian University of Health Sciences, Eiveniust. 2, LT-50009, Kaunas, Lithuania

Received: January 27, 2017; Accepted: February 28, 2017; Published: March 02, 2017

Abstract

Crohn’s and Hirschsprung’s diseases are two different conditions of intestinal tract though both of them are genetically predisposed. Each disease have genetic mutations in some genes, however there are no evidence that there are mutations common to both conditions.

We present 3 clinical cases of patients who underwent surgery in infancy for Hirschsprung’s disease. Later in early childhood all the patients developed clinical symptoms of inflammatory bowel disease and Crohn’s disease was diagnosed. Both conditions were confirmed histologically. After introducing the treatment for Crohn’s disease positive effect was shown. These cases raise the hypothesis that the two conditions may have similarities in etiology and pathogenesis and may represent a spectrum of intestinal inflammatory diseases in children.

Keywords: Hirschsprung’s disease; Crohn’s disease; Pediatrics

Case Presentation

Case 1

Normally born healthy boy was constipated from birth and meconium ileus was present. He started to regurgitate frequently and suffered from chronic abdominal distention when he was 1 month old. At the age of 7 months biopsy from rectum was done and histopathology showed findings typical for Hirschsprung’s disease (Figure 1); thus hemicolectomy was performed. Being 4 years old patient suffered from abdominal pain and more frequent stools, as well unexplained fever episodes. The diagnosis of cystic fibrosis and tuberculosis were not confirmed. He constantly had low levels of hemoglobin (Hb), elevated rates of erythrocyte sedimentation (ESR) as well as C-reactive protein (CRP) and platelets (PLT). From 7 till 11 years old patient wasn’t gaining weight, his bone age was delayed. Several times positive effect of antibacterial treatment (metronidazole and cefuroxime) was observed when the boy had sub-febrile temperature, abdominal pain and loose stools. Any possible infection wasn’t confirmed thus colonoscopy with biopsy was performed. Colonoscopy showed inflammatory changes in transversal, ascending and cecum parts of colon mucosa and edematous stenosis of ileocecal part; histopathology confirmed active chronic colitis with reactive lymphoid hyperplasia (Figure 2) - Crohn’s disease was diagnosed. Treatment with steroids and azathioprine was initiated, though despite the treatment, relapses with diarrhea, abdominal pain and inflammatory blood changes (CRP - >140 mg/l, PLT - > 700 x 109/l) occurred. 7 months later after the diagnosis of Crohn‘s disease Infliximab was started. 3 weeks after the last induction dose symptoms of intestinal obstruction occurred - patient was vomiting after greater meal, suffered from abdominal pain and lost weight.