A Case of Undiagnosed Pediatric Crohn’s Disease Causing Acute Abdomen

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  • Hirohata Yoshiaki
    Department of Pediatric Surgery, Kyoto Prefectural University of Medicine
  • Aoi Shigeyoshi
    Department of Pediatric Surgery, Kyoto Prefectural University of Medicine
  • Takayama Shohei
    Department of Pediatric Surgery, Kyoto Prefectural University of Medicine
  • Kim Kiyokazu
    Department of Pediatric Surgery, Kyoto Prefectural University of Medicine
  • Higashi Mayumi
    Department of Pediatric Surgery, Kyoto Prefectural University of Medicine
  • Fumino Shigehisa
    Department of Pediatric Surgery, Kyoto Prefectural University of Medicine
  • Furukawa Taizo
    Department of Pediatric Surgery, Kyoto Prefectural University of Medicine
  • Tajiri Tatsuro
    Department of Pediatric Surgery, Kyoto Prefectural University of Medicine Department of Pediatric Surgery, Kyushu University Graduate School of Medical Sciences

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Other Title
  • 急性腹症で発症した未診断小児Crohn病の1例
  • キュウセイ フクショウ デ ハッショウ シタ ミシンダン ショウニ Crohnビョウ ノ 1レイ

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Abstract

<p>A 12-year-old girl had been suffering from abdominal pain, constipation, and vomiting for 3 months, and eventually presented failure to thrive. These symptoms worsened suddenly, and she visited a previous hospital and was suspected of having bowel obstruction. She was referred to our department. Abdominal CT showed thickening and narrowing of the jejunal wall, dilation of the proximal intestinal tract, and a closed loop. She was diagnosed as having acute abdomen due to small bowel obstruction, and an emergency laparotomy was performed. During surgery, no ischemic change in the intestine was observed. Massive edema, wall thickening, and dilation of the jejunum were noted, and a mass formation involving the omentum was also observed. The affected jejunum was resected, and the specimen showed a cobblestone appearance and longitudinal ulcers on the mucosa. The histopathological findings revealed a noncaseating granuloma, and her final diagnosis was Crohn’s disease. Her postoperative course was uneventful, infliximab was started from the 14th postoperative day, and she was discharged on the 32nd day. Surgeons should be aware of the possibility of future multiple surgeries and postoperative enteral during emergency surgery for undiagnosed pediatric Crohn’s disease.</p>

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