Ulcerative colitis in infancy: our results

Leili Mohajerzadeh, Ahmad khaleghnejad Tabari, Alireza Mirshemirani, Naser Sadeghian, Mohsen Rouzrokh, Naghi Dara

Abstract


558

Introduction: Ulcerative colitis (UC) is a debilitating disorder of colon. The incidence of UC peaks in the age group of 15 to 25, and only 1% are infantile. Despite initial medical treatment, in refractory cases, colectomy is needed. There are few studies regarding surgical results of treatment of UC in infancy.

 

Material & Methods: In our descriptive retrospective study we reviewed medical files of infants with ulcerative colitis that consulted with us for surgery between 2009 and 2014. Age at onset, family history of inflammatory bowel disease, symptoms of onset, colonoscopic findings, duration of Medical treatment, Indication of surgery, Type of operation, surgical complications and their Management and mortality was recorded.

 

Results: We found five patients with the diagnosis of UC in their first year of life; 4 boys and 1girl. The mean age of onset of the disease was 35 days (range 3-60). The mean age of patients at the time of surgical consult was 7 months. The disease began in 3 patients with watery diarrhea. Family history was positive in only one of our cases. He had sever FTT with no response to medical treatment which was an indication for surgery and he underwent total proctocoletomy, ileoanal anastomosis and loop ileostomy which failed and 3 days after the first operation we performed an end ileostomy. Two cases had colon perforation following their colonoscopy and one of them (a 4 month girl) expired before laparotomy and the other (a 12 month boy) underwent colostomy creation while he was in septic shock. The fourth patient was a 2 day old neonate with abdominal distention and intestinal obstruction. Rectal biopsy showed agangliosis so he underwent a transanal pull through procedure with a diagnosis of hirschsprung’s disease. After surgery he experienced recurrent watery diarrhea and further diagnostic investigations brought about the diagnosis of UC. Our last patient was a 3 day old neonate that underwent ileostomy in the initial surgery with suspicion of total colonic agangliosis and underwent subtotal colectomy when he was 2 months old. At 1.5 years he developed toxic mega-colon in the remnant of colon when he was old and thus was referred to us and underwent colostomy. After 3 month the final surgery was carried out.

 

Conclusions: If a child presents with recurrent bloody or watery diarrhea even in infancy, UC should be considered as a differential diagnosis. The pattern of the disease in infancy appears more rigorous. Evidence-based management of UC presenting in infancy is incomplete but early surgical attempt can reduce catastrophic results.


Keywords


infancy; ulcerative colitis; inflammatory bowel disease

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References


R Loftus EVJr: Clinical epidemiology of inflammatory bowel diseses: incidence, prevalence, and environmental

influences. Gastroenterology 2004; 126: 1504-17.

Griffiths AM, Hugot JP: Inflammatory bowel disease. In: Walker WA, Goulet O, Kleinman RE,

edi. Pediatric Gastrointestinal Disease: 4th ed. BC Decker study Gut 2005, 54: 357-363.

Ruemmele FM, El Khoury MG, Talbotec C, et al: Characteristics of inflammatory bowel disease with onset during

the first year of life. J Pediatr Gastroenterol Nutr 2006; 43:603-9.

Jang ES, Lee DH, Kim J: Age as a clinical predictor of relapse after induction therapy in ulcerative colitis.

Hepatogastro-enterology. 2009; 56:1304–9.

Kim SC, Ferry GD: Inflammatory bowel disease in pediatric and adolescent patients: Clinical, therapeutic and

psychosocial considerations. Gastroenterology 2004; 126:1550–60.

Kappelman MD, Graud RJ: Does inflammatory bowel disease develop in infants? Inflamm Bowel Dis. 2009;

:1438–47.

Ahuja V, Tandon RK: Inflammatory bowel disease in the Asia-Pacific area: a comparison with developed countries and regional differences. J Dig Dis. 2010;11(3):134-47.

Rukunuzzaman Md , Bazlul Karim A. S. M: Ulcerative Colitis in Infancy. Saudi J Gastroenterol. 2011; 17(6): 414–

Hyams JS: Chronic ulcerative colitis. In: Kliegman RM, Behrman RE, Stanton BF, editors. Nelson Textbook of

Pediatrics. Saunders: Philadelphia; 2007. pp. 1577–80.

Croft NM: Pediatric Gastrointestinal Disease. Pennysylvania: BC Decker Inc; 2008. Ulcerative colitis; pp. 519–43.

- Jenkins HR, Pincott JR, Soothill JF, et al. Food allergy: the major cause of infantile colitis. Arch Dis Child 1984; 59: 326–9.

D’Agata ID, Paradis K, Chad Z, et al: Leucocyte adhesion deficiency presenting as a chronic ileocolitis. Gut 1996; 39: 605–8.

Ojuawo A, St Louis D, Lindley KJ, et al: Non-infective colitis in infancy: evidence in favour of minor immunodeficiency in its pathogenesis. Arch Dis Child 1997; 76: 345–8.

Omar I Saadah: Anti-TNFα antibody infliximab treatment for an infant with fistulising Crohn’s disease BMJ Case Rep. 2010; 2010: bcr04.2009.1739

Ojuawo A, Louis D, Lindley KJ, et al: Non-infective colitis in infancy: evidence in favour of minor immunodeficiency in its pathogenesis. Arch Dis Child 1997;76:345-348.

Marks D J, Seymour C R, Sewell G W, et al: Inflammatory bowel diseases in patients with adaptive and complement immunodeficiency disorders. Inflamm Bowel Dis. 2010;16(11):1984-92.

Nicole P.S, Muhammad E.B, Daniel P, et al: BAPS UK: inflammatory bowel disease surgical practice survey. Journal of Pediatric Surgery 2007; 42: 296– 299.

Ghosh S, Shand A, Ferguson A: Ulcerative colitis. BMJ 2000;7242:1119- 23.

Benchimol EI, Fortinsky KJ, Gozdyra P et al: Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 2011; 17:423–439.

Jakobsen C, Paerregaard A, Munkholm P et al: Pediatric inflammatory bowel disease: increasing incidence, decreasing surgery rate, and compromised nutritional status: a prospective population-based cohort study 2007–2009. Inflamm Bowel Dis 2011; 17(12):2541–50.

Van Limbergen J, Russell RK, Drummond HE, et al: Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology 2008; 135:1114–1122.

Jakobsen C, Bartek J Jr, Wewer V, et al: Differences in phenotype and disease course in adult and paediatric

inflammatory bowel disease—a population-based study. Aliment Pharmacol Ther 2011; 34:1217–1224.

Najafi Sani M, Khodadad A, Fallahi GH, et al: Inflammatory bowel disease in infancy. Govaresh 2008; 13(1): 48- 53.

Ruemmele FM, El Khoury MG, Talbotec C, et al: Characteristics of inflammatory bowel disease with onset during the first year of life. J Pediatr Gastroenterol Nutr 2006;43:603-9.

Marx G, Seidman E, Martin S, et al: Outcome of Crohn’s diseases diagnosed before two years of age. J pediatr 2002;470-3.

Heymen MB, Kirshner BS, Gold BD, et al: Children with early onset inflammatory bowel disease: analysis of a pediatric IBD consortium registry. J Pediatr 2005; 146:35-40.




DOI: https://doi.org/10.22037/irjps.v2i1.12054

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