Chronic Diarrhea in an Infant With Malrotation: A Diagnostic Dilemma

Abstract

In children, diarrhea has a global incidence of 2.7 episodes per child-year and contributes to significant disease burden and mortality in children under 5 years of age. Chronic diarrhea, defined as diarrhea lasting for more than 2 weeks, may be particularly challenging to evaluate and manage in children under 2 years of age. While most have infectious enteritis or cow milk protein intolerance, others have conditions such as malnutrition, anatomic abnormalities, or congenital enteropathies that can be challenging to diagnose and treat. We present here a complex case of chronic diarrhea in an infant and highlight such diagnostic and therapeutic challenges.

Neonatal Crohn’s Disease Caused by Compound Homozygous Mutation in IL-10RA: A Case Report

“…It is a complicated multifactorial chronic gastrointestinal illness [1,2,4]. Consanguinity is a powerful predictor of IBD and the incidence is growing in the pediatric age group, while the percentage of infantile and neonatal disease is only 1% of pediatric overall [7]. Genes, the immune system and the usual flora in the intestines all have a role in the etiology of Crohn's disease.…”

“…As IBD in very young children can be resistant to many of the standard medications for IBD, they require strong-growing therapeutic medication to achieve complete remission, parenteral nutrition, early administration of steroids and immunosuppressants and more surgical medicine [8]. Infantile-onset, or Very Early-Onset, IBD (VEO-IBD) differs from adult-onset or adolescent-onset IBD in terms of clinical characteristics and responsiveness to standard medication [7]. The fact that VEO-IBD patients frequently have a significantly stronger family history and genetic component to the disease is another difference [6].…”

“…Few patients with malrotation and IBD have been documented [7]. Five examples of intestinal malrotation in adults with concomitant Crohn's disease and midgut malrotation were reviewed and reported by Silverman J [8].…”

“…Crohn's Disease (CD) is an Inflammatory Bowel Disease (IBD) subtype; it is a chronic idiopathic transmural inflammatory condition that may involve the entire gastrointestinal tract with an unclear cause [1][2][3][4]. Patients younger than 2 years old account for 1% of all IBD, with an increasing incidence readily occurring [5][6][7][8][9][10][11]. Compared to adults and adolescents with lateonset IBD, children with VEO-IBD had more severe gastrointestinal symptoms, including significant colonic involvement, severe colitis with hematochezia, perianal abscess and fistulae.…”