Perianālas Krona slimības ārstēšanas sarežģījumi
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads: Krona slimības, kas manifestējas bērna vecumā, incidence un prevalence pieaug. Bērnu populācijā slimība raksturojas ar smagāku un komplicētāku gaitu. Krona slimība ir multifaktoriāla poliģenētiska slimība, kas raksturojas ar transmurālu gastrointestinālā trakta iekaisumu un bieži komplicējas ar fistulu attīstību.
Klīniskā gadījuma prezentācija: 13 gadus veca meitene tika nosūtīta uz Bērnu klīnisko universitātes slimnīcu sakarā ar klīnisko simptomu un analīžu pasliktināšanos. Pacientei bija smagāka anēmija, drudzis, caureja, svars 26,8kg (-2,7 standartdeviācijas). No anamnēzes zināms, ka pacientei 2 mēnešus atpakaļ tika diagnosticēta Krona slimība, kas skar tievās zarnas terminālo daļu un resno zarnu. Tiek uzsākta kortikosteroītu terapija.
Magnētiskās rezonanses enterogrāfija un magnētiskās rezonanse ar intravenzo kontrastvielu perianālajam reģionam atklāja terminālu ileītu, pankolītu, perianālu infiltrātu un fistulu uz plkst. 5:00. Tiek uzsākta antibakteriālā terapija ar metronidazole un ciprofloksacīnu, bioloģiskā medikamenta TNFα inhibitora ievadīšana. 2 nedēļas pēc terapijas uzsākšanas paciente sāka sūdzēties par sāpēm perianālajā reģionā, ultrasonogrāfijas izmeklējumā atklāja abscesu. Tika veikta perianālā abscesa ķirurģiska incīzija un drenāža, abscesa dobumā atrada fistulas trakta atveri, rektālā izmeklēšana atklāja suprasinkterisku fistulas atveri uz plkst.5:00, tāpēc tika ievietota Seton ligatūra fistulas traktā, lai nodrošinātu drenāžu un veicinātu fistulas slēgšanos. Pēc 2 mēnešiem izveidojās vēl 2 fistulas ar atverēm uz plkst.7:00, vēl viena Seton ligatūra tika ievietota.
4 mēnešus pēc terapeitiskas uz ķirurģiskas slimības ārstēšanas tika novēroti uzlabojumi un perianālās fistulas bija slēgušās.
Secinājumi: Pacientiem ar komplicētu perianālu Krona slimību multidisciplināra pieeja ir svarīga. Seton procedūra nodrošina fistulas drenāžu un veicina tās slēgšanos.
Introduction: The incidence and prevalence of childhood onset Crohn’s disease have risen in recent years and in children population present often with a more complex disease course. Crohn’s disease is multifactorial polygenetic disease characterized by chronic transmural inflammation of gastrointestinal tract and is often complicated by fistulas. Case presentation: A 13 years old girl was referred to Children’s Clinical University Hospital due to clinical presentation and lab test worsening. She had deeper anemia, fever, diarrhea, weight was dropped to 26,8 kg (-2,7 Standard Deviation). From the anamnesis we know that two month ago patient was diagnosed with Crohn’s disease involving the terminal ileum and colon. She was commenced on corticosteroids. Magnetic resonance enterography and magnetic resonance with intra venous contrast for perianal region revealed terminal ileitis, pancolitis, perianal infiltrate and fistula at 5 o’clock. Biological drug TNFα inhibitor and antibacterial therapy with metronidazole and ciprofloxacin was started. After two weeks of therapy patient started complaining about perianal pain, ultrasonography revealed abscess. Patient underwent perianal abscess surgical incision, drainage; in abscess cavity founded fistular tract orifice, rectal examination revealed suprashincteric fistular orifice at 5 o’clock therefore a seton was placed in the fistular tract to facilitate drainage and progressive closure. Two new fistulas formed after two months with orifice at 7 o’clock one more seaton was inserted. After 4 mounth of medical and surgical disease management improvement was seen and perianal fistulas was closed. Conclusion: A multidisciplinary assessment of patients with complex perianal Crohn’s disease with a coordinated medical and surgical approach is crucial. Seton procedure facilitate drainage and progressive closure.
Introduction: The incidence and prevalence of childhood onset Crohn’s disease have risen in recent years and in children population present often with a more complex disease course. Crohn’s disease is multifactorial polygenetic disease characterized by chronic transmural inflammation of gastrointestinal tract and is often complicated by fistulas. Case presentation: A 13 years old girl was referred to Children’s Clinical University Hospital due to clinical presentation and lab test worsening. She had deeper anemia, fever, diarrhea, weight was dropped to 26,8 kg (-2,7 Standard Deviation). From the anamnesis we know that two month ago patient was diagnosed with Crohn’s disease involving the terminal ileum and colon. She was commenced on corticosteroids. Magnetic resonance enterography and magnetic resonance with intra venous contrast for perianal region revealed terminal ileitis, pancolitis, perianal infiltrate and fistula at 5 o’clock. Biological drug TNFα inhibitor and antibacterial therapy with metronidazole and ciprofloxacin was started. After two weeks of therapy patient started complaining about perianal pain, ultrasonography revealed abscess. Patient underwent perianal abscess surgical incision, drainage; in abscess cavity founded fistular tract orifice, rectal examination revealed suprashincteric fistular orifice at 5 o’clock therefore a seton was placed in the fistular tract to facilitate drainage and progressive closure. Two new fistulas formed after two months with orifice at 7 o’clock one more seaton was inserted. After 4 mounth of medical and surgical disease management improvement was seen and perianal fistulas was closed. Conclusion: A multidisciplinary assessment of patients with complex perianal Crohn’s disease with a coordinated medical and surgical approach is crucial. Seton procedure facilitate drainage and progressive closure.
Description
Pediatrija
Pediatrics
Veselības aprūpe
Health Care
Pediatrics
Veselības aprūpe
Health Care
Keywords
Pediatrija, Krona slimība, perianāla slimība, fistula, ķirurģija., Pediatrics, Crohn’s disease, perianal disease, fistula, surgery.