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previously visited 10 YEAR OLD MALE WITH HISTORY OF NAUSEA AND VOMITING 3 WKS PRIOR Random Case
Authored By: Grace Kalish, Resident, University of Washington, Washington, USA.
Patient: 10 year old male
History: 10 year old male with history of nausea and vomiting 3 weeks prior to presentation.  The child continued to have stomach aches and back pain for 3 wks.  No bloody stool.
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Findings: There is an approximately 25 cm segment of bowel with abnormal separation and luminal narrowing, which persists throughout the study.  There is mural nodularity, consistent with inflammation.  TI was normal.
Diagnosis: Crohn's disease
Discussion:

Because of the UGI with small bowel follow through, this child had a GI consult and had a colonoscopy performed, which showed 3 aphthous ulcers in the cecum.  Pathology of colonoscopy specimens revealed mild chronic granulomatous colitis.  Gastric biopsy also showed chronic active gastritis.

Crohn's disease is thought to be rising in the pediatric population, as it is among caucasian adults (according to population studies conducted in Scotland and in Wales).

A recent French study reports that 19% of the pediatric patients diagnosed with Crohn's disease over an 11 year period (n=367) have findings isolated to the small bowel. 

Other studies suggest that in children, because lymphoid follicles (thought to play a role in inflammatory reaction) are underdeveloped in the TI and in the small bowel, often initially present with isolated colitis.

References:

1.  Meinzer U, Idestrom M et. al. Ileal involvement is age dependent in pediatric Crohn's disease.  Inflamm Bowel Dis.  2005 Jul;11(7):639-44.

2.  Auvin S, Molinie F, Gower-Rousseau C et. al.  Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France (1988-1999).  J Pediatr Gastroenterol Nutr. 2005 Jul;41(1):49-55.

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Additional Details:

Case Number: 6549789Last Updated: 09-22-2006
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Anatomy: Gastrointestinal (GI)   Pathology: Non-Infectious Inflammatory Disease
Modality: GIAccess Level: Readable by all users
Keywords: crohn'sContained in: ahmeeed
Case has been viewed 1025 times.

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