Initial crohn’s disease flare-up following an anal trauma 
in a 2.5-year-old boy: a case report

Samady Khanghah , Ali; Khalesi , Maryam; Hokmabadi, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Atqiaee, Khashayar

Volume 81, Issue 8 (November 2023) Tehran Univ Med J 2023, 81(8): 616-620 | Back to browse issues page

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Samady Khanghah A, Khalesi M, Hokmabadi D O P F O M M U O M S M I, Atqiaee K. Initial crohn’s disease flare-up following an anal trauma in a 2.5-year-old boy: a case report. Tehran Univ Med J 2023; 81 (8) :616-620
URL: http://tumj.tums.ac.ir/article-1-12750-en.html

Initial crohn’s disease flare-up following an anal trauma in a 2.5-year-old boy: a case report

Ali Samady Khanghah¹

, Maryam Khalesi²

, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Hokmabadi³

, Khashayar Atqiaee ^*

⁴

1- Department of Surgery, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
2- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3- Department of Cellular and Molecular Biology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4- Department of Pediatric Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Ian. , khashayaratqiaee@gmail.com

Abstract: (362 Views)

Background: Crohn's disease is considered a heterogeneous disorder with multi-factorial etiologies, in which the interaction of genetics and environment manifests the disease. Adverse childhood experiences can affect future physical and mental health outcomes. The rich innervation of the intestine with the Vagus nerve and hormonal interactions on the one hand and the constant contact of the digestive system with various pathogenic and non-pathogenic antigens have a proven role in autoimmune diseases and can gradually be chosen as a therapeutic goal.

Case Presentation: We are reporting a case of Crohn's flare-up after trauma in a pediatric case. A 2.5-year-old male with a through and through anal trauma was presented in Akbar Children's Hospital, Mashhad, Iran, Spring 2023 with active bleeding but conscious. He then underwent a physical examination under general anesthesia in the operating room. At the Lithotomy position, a penetrating wound at the 3 o'clock anal verge and a tear in the perineal area at 9 o'clock, which, according to the evidence of pus discharge, were seen hours after the incident which was irrigated with normal saline and Hydrogen Peroxide respectively. Due to the contamination of the area, a supportive colostomy was decided to be closed after six months. At the appointed time during the colonoscopy, the pediatric gastroenterologist noticed extensive inflammation in the distal patch of the colon, which was consistent with Crohn's disease. Histopathological studies then confirmed this diagnosis. This was even though there were no symptoms of inflammatory bowel disease in the history of the boy's illness before the accident. The patient is then treated with prednisolone, Asacol, and ciprofloxacin, and after the disease subsides, the colostomy surgery team closes the disease.
Conclusion: Trauma can be an immune-disrupting factor in the digestive system, and trying to reset the brain-gut axis can be chosen as a therapeutic goal.

Keywords: anal trauma, child, crohn’s disease, flare up.

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Type of Study: Case Report |