Gastrointestinal complications of chronic granulomatous disease: case report and literature review.
Barton LL. Moussa SL. Villar RG. Hulett RL.
Department of Pediatrics, University of Arizona, Tucson, USA.
Chronic granulomatous disease (CGD), an inherited disorder of phagocytic leukocyte function, is characterized by recurrent infections with catalase-positive organisms. Gastrointestinal (GI) tract involvement, present in the majority of affected individuals, may be present initially and recurrently, mimics other entities such as inflammatory bowel disease, and causes substantive morbidity and mortality. Disorders of motility, ulceration, obstruction, and infection (e.g., abscesses) occur from the mouth to the anus and stereotypically manifest with vomiting, diarrhea, abdominal pain, weight loss, and fever. Careful physical examination, in concert with appropriate diagnostic studies, is necessary to delineate intraabdominal pathologic processes. Abdominal radiographs, ultrasonography, computerized tomography, and endoscopy are useful ancillary diagnostic procedures. Drainage of accessible abscesses, antimicrobial therapy based on organisms cultured from blood and tissue, and interferon gamma may lead to suppression or eradication of infections and resolution of symptoms. Corticosteroids are useful for gastric outlet obstruction and sulfasalazine and cyclosporine for large bowel disease. Gallbladder dysfunction may be ameliorated, as in our patient, with administration of cholestyramine.
Colonic polyps in children: frequently multiple and recurrent.
Pillai RB. Tolia V.
Division of Gastroenterology, Wayne State University School of Medicine, Detroit, MI, USA.
A retrospective chart review on 77 children and adolescents (45 males and 32 females) with colorectal polyps seen over a 15-year period (1980-1994) was undertaken. Their presenting symptoms, demographic data, methods of diagnosis, pathologic diagnosis, and outcome were assessed. The age at presentation varied from 6 months to 19 years (mean age 77 months), 66.2% presenting under 6 years of age. The presenting symptoms were rectal bleeding in 71 patients, mass per rectum in 12, abdominal pain in nine, diarrhea in nine, vomiting in two, and one patient was asymptomatic. Air contrast barium enema was confirmatory in 41/54 patients (76%). Polyps were palpable in 16 patients during the rectal examination. A single polyp was present in 50 patients, whereas two to five polyps were present in 20 patients, and more than five in seven patients. Successful endoscopic removal was accomplished in 71/73 patients (97.3%). In 83.1% of patients polyps were located in the rectosigmoid area and in 32.5% polyps occurred proximal to the sigmoid colon. However, multiple polyps in the same location or at other locations were also present simultaneously. Recurrence was observed in five of 63 patients (7.9%) with juvenile polyps, in one patient with infantile polyposis, and in one with solitary adenomatous polyp. We conclude that a full colonoscopic evaluation should be performed in all patients with suspected polyps if feasible, for multiple polyps occurred in 35% of children without polyposis syndromes in this series. Parents of patients with more than three polyps and/or a family history of juvenile polyposis should be warned regarding the possibility of an increased risk of malignancy in future if polyps continue to recur.
Characterization of failure to imbibe in infants.
Gremse DA. Lytle JM. Sacks AI. Balistreri WF.
Division of Pediatric Gastroenterology, University of South Alabama, Mobile 36640-0130, USA.
The term failure to imbibe is proposed to describe infants with failure to thrive due to poor feeding. Feeding assessment was performed in 128 patients: 43 healthy controls, 53 diseased controls, 12 with nonorganic failure to thrive, and 20 with failure to imbibe. Infants with failure to imbibe required a significantly longer time to feed compared with other infants. In contrast to other infants with nonorganic failure to thrive, patients with failure to imbibe were more likely to need pediatric subspecialty care and nasogastric or gastrostomy tube feeding. Since these patients may have treatable conditions, infants with failure to imbibe merit further investigation.
Use of the rectal examination on children with acute abdominal pain.
Scholer SJ. Pituch K. Orr DP. Dittus RS.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
The purpose of this study was to determine the frequency with which general pediatricians perform a rectal examination on children with a complaint of acute abdominal pain and to determine factors associated with performing a rectal examination. Children were eligible for the study if they were 2 to 12 years of age and presented to the clinic or emergency department of a municipal teaching hospital with a complaint of abdominal pain of less than or equal to three days' duration. Measured variables included demographic characteristics and presenting signs and symptoms. For each patient, a clinical reviewer (1) assigned a final diagnosis, (2) determined whether a rectal examination had been performed, and (3) assessed the clinical contribution of the rectal examination findings. For 1,140 children presenting for a nonscheduled visit with acute abdominal pain, a rectal examination was performed on 4.9% (56/1,140). Using multiple logistic regression, children were more likely to have a rectal examination performed if they had abdominal tenderness (odds ratio [OR] = 3.3 and 95% confidence interval [CI], 1.8 to 6.0), a history of constipation (OR = 6.0 and 95% CI, 2.3 to 15.3), or a history of rectal bleeding (OR = 9.1 and 95% CI, 2.9 to 29). Children were less likely to have had a rectal examination performed if they presented with associated symptoms of cough (OR = 0.32 and 95% CI, 0.14 to 0.74), headache (OR = 0.15 and 95% CI, 0.05 to 0.46), or sore throat (OR = 0.28 and 95% CI, 0.08 to 0.91). The final diagnoses of 12 children who had clinically contributory findings on rectal examination included: constipation (5), gastroenteritis (3), appendicitis (2), abdominal adhesions (1), and abdominal pain of unclear etiology (1). General pediatricians infrequently perform a rectal examination on children who present with a complaint of acute abdominal pain. Clinical factors affect the likelihood of whether a rectal examination is performed.