Perianal lesions as an unusual first manifestation of Crohn’s disease in pediatric patients – case series

Abstract

Primary symptoms of Crohn’s disease usually include, among others, abdominal pain and cramping, recurrent diarrhea, fever and weight loss. The aim of this study was to show the effectiveness of ultrasound in the diagnosis and assessment of the extent of perianal complications in Crohn’s disease. Five patients (four boys and one girl) aged from 13 to 16 years, with prolonged pain in the perianal area, which worsened when sitting, were admitted to the Department of Pediatric Gastroenterology between 2017 and 2019. Each patient underwent intestinal ultrasound with a high frequency 7–12 MHz linear probe and transperineal ultrasound to assess the anal canal and the surrounding soft tissues. In each case, the echogenicity of the bowel wall was assessed for mural stratification and possible thickening. Anorectal fistulas were detected in all the five patients. Three patients (12 y.o. male, 12 y.o. female and 16 y.o. male) presented with perianal abscesses drained by fistulas. In the first patient the fistula was limited to the perianal soft tissue (22 × 23 mm); in the second patient it was localized within the ischioanal region (40 × 50 mm); and in the third patient (5–6 mm abscess) the fistula was with a hypoechoic fistulous tract reaching the sphincter. All of the patients were eventually diagnosed with Crohn’s disease as a result of further clinical workup. Ultrasound examination is a non-invasive, well-tolerated modality for the evaluation of Crohn’s disease activity and its possible complications, e.g. fistulas and abscesses. Ultrasound is especially useful in patients who require repeated follow-up investigations.

Early diagnosis and treatment of perianal Crohn's disease in a 1‐year‐old infant: Case report and review of literature

“… 4 Typically, the primary symptoms are gastrointestinal symptoms such as abdominal pain, recurrent diarrhea, fever, and weight loss. 4 …”

“…Occasionally, patients with colonic involvement may also experience fatigue, anorexia, rectal bleeding, or bloody diarrhea. 4 External and rectal examinations followed by endoscopy, pelvic magnetic resonance imaging (MRI), and surgical evaluation are particularly helpful for diagnosis. Pelvic MRI is the gold standard for the assessment of perianal fistulas and abscesses.…”

Saudi Arabia consensus guidance for the diagnosis and management of adults with inflammatory bowel disease

“…[ 76 ] It can also be the first manifestation in CD, and the patient might have a normal ileo-colonoscopy. [ 77 , 78 ] Clinical and imaging findings are essential for diagnosing and characterizing perianal disease.…”

Paediatric sacrococcygeal teratoma detected by transperineal sonography

“…Transperineal ultrasound has been recently documented for use in neonatal anal positioning, 3 children with ambiguous genitalia, 4 and a variety of other pathologies including posterior urethral valves, imperforate anus, 5 cervical or vaginal atresia, 6 anorectal malformations, and fistula 7,8 …”

“…Transperineal ultrasound has been recently documented for use in neonatal anal positioning, 3 children with ambiguous genitalia, 4 and a variety of other pathologies including posterior urethral valves, imperforate anus, 5 cervical or vaginal atresia, 6 anorectal malformations, and fistula. 7,8 A paediatric renal ultrasound protocol invariably includes transabdominal examination of both kidneys, the bladder, and ureteric region ideally with an 8-5 MHz or 9-2 MHz curvilinear probe. Examination may also involve a linear transducer for high-resolution images of more superficial structures.…”