Today, a friend called to say that I saw the photos of my patients on the Internet, I went home to look online, it turns out that a few days ago, many newspapers in Guangzhou reported that we successfully diagnosed and treated a case of Crohn’s disease in minors, the news was reproduced by a number of newspapers network, the following is the “Guangzhou Daily” report reproduced by CCTV International.
(Reporter Wu Ren, correspondent Dai Lijuan) Since 10 years ago, Xiao Wang, who lives in Panyu, has inexplicably suffered from malnutrition, and this year, at the age of 16, she is just over 1.3 meters tall and weighs only 23 kilograms. A few days ago, she was finally diagnosed in the First Affiliated Hospital of Guangzhou Medical College: it turns out she has a “refrigerator disease” called a rare intestinal disease.
Yesterday, the reporter saw Xiao Wang, who had received minimally invasive surgery in the hospital ward. Her big eyes make her look very pleasing, but her skinny arms and legs clearly look different from her peers. She said she had been suffering from repeated high fevers and diarrhea since ten years ago, and since the age of 12, her condition had worsened, with not only shorter intervals between attacks, but also frequent vomiting. Each time the local hospital prescribed her some anti-inflammatory drugs that would bring the fever down, but it would come back shortly after.
The family always thought that Xiao Wang’s stunted growth was caused by endocrine disorders. Not long ago, Xiao Wang was admitted to the endocrinology department of Guangzhou Medical College. The examination found that her body development was only equivalent to that of a 12-year-old child, but the hormone secretion in her body was normal, indicating that there was another reason for her condition. After being transferred to the Department of Gastroenterology, a colonoscopy revealed a pebble-like protrusion in one section of her colon, making the intestine severely obstructed and even making it difficult to extend the colonoscope further in. Doctors considered that what Xiao Wang had might be Crohn’s disease, an idea that was confirmed in the post-operative pathology report.
”Crohn’s disease is a very rare inflammatory disease of the intestine, and even specialists don’t always think about it at the time of diagnosis.” Chen Xueqing, M.D., of the hospital’s Department of Gastroenterology, said the hospital generally sees five or six cases of Crohn’s disease each year, but most are adults, and it is rare for them to develop in childhood, like Xiao Wang. The incidence among children in China is only 0.2 to 8.5 per 100,000, but it is estimated to rise gradually, as it has in Europe and the United States. “The consequences of having the disease in children are more serious, because the diarrhea and intestinal obstruction caused can cause malnutrition, which in turn affects development.”
Chen Xueqing told reporters that Crohn’s disease also has an alias – refrigerator disease, because the medical profession found that the incidence of this disease in which region the popularity of refrigerators rose, the incidence of the disease in that place will rise. “But in fact the cause of this disease is not clear, it is certain that genetics, autoimmunity, environmental pollution and industrialization related. The prevalence of refrigerators may just be a sign of industrialization.”
Recently, doctors performed minimally invasive surgery for Xiao Wang: four small holes were opened in the belly, the most serious 20 cm part of the intestinal obstruction was removed, and then the front and back of the intestine was joined together. one week after the surgery, Xiao Wang was able to be discharged from the hospital, and his weight was one kilogram heavier. However, there is no cure for Crohn’s disease, surgical treatment can only relieve the condition, “if the post-operative control is not good, the chance of recurrence is 100%”.
Why is the bone age of a 17-year-old girl only 12 years old?
As the saying goes, women are 18 years old, the young girl in the above news was 16 years old when she was admitted to the hospital, and she turned 17 years old on the ninth day (June 21) after the surgery, which is 18 years old according to her imaginary age.
In order to find the cause, she and her family have been visiting many hospitals over the years, and only this time, through the cooperation of the Department of Endocrinology, Gastroenterology and Gastrointestinal Surgery, we found the cause of the problem – Crohn’s disease, a rare gastrointestinal disease. According to the literature, 10%-40% of minors with Crohn’s disease have developmental delays, mainly because: Crohn’s disease accumulates the gastrointestinal tract, especially the small intestine, and repeated inflammation leads to abdominal pain and diarrhea and bloating, which can lead not only to insufficient feeding, but also to malabsorption. Without nutrition, how can you develop properly?
The following is a picture of the girl with her sister.
So, after finding the cause, will this girl be able to gain developmental maturity through treatment?
Based on past clinical experience and literature, as long as the epiphyseal plate is not closed, most of them can be treated properly and have a chance to mature. Fortunately, the photos show that the epiphyseal plate has not yet closed, so she may still be able to develop. I sincerely hope that in a few years, she will grow up to be a tall and graceful girl like her sister. Laparoscopic surgery allows her to wear navel-less dresses
After treatment in gastroenterology, the obstruction was not lifted. Before she was transferred to our gastrointestinal surgery department on June 9, 2009, she had been unable to eat vegetables, noodles, or even congee for several weeks, and could only drink water and enteral nutrition without forming stool. He needed surgery to remove the ileocecum.
Before the operation, our surgeons discussed that if the traditional open surgery was used to remove the ileocecal part, it would not only be traumatic and difficult for the patient to tolerate with poor nutrition, but also easy for intestinal adhesions after the operation, and would leave a long incision scar in the patient’s abdomen, which would affect the aesthetics, so we decided to use the latest minimally invasive laparoscopic surgery to reduce trauma and scar. After thorough preparation, the laparoscopic surgery was successful on June 12, 2009, and the following is the situation when I (first from the right) and my colleagues performed the laparoscopic surgery on the patient.
The postoperative pathology report confirmed Crohn’s disease. The following is a picture of the specimen (size about 20X8X8M) without dissection of the intestinal canal after surgical resection.
The following is a picture of the specimen of the dissected intestinal canal after surgical resection.
The patient recovered well after the surgery, and her intestines returned to patency in 3 days. On the 8th day, she happily tasted the longevity package and cake prepared by her family for her birthday, and when she weighed herself on the 10th day, oh, she was 1 kg heavier.
When designing the incision, we used our brains a little. Usually, after laparoscopic operation, a small incision is needed to remove the diseased intestinal tube for resection and anastomosis, and this incision is usually a straight incision next to the umbilicus. The following is a photo of the postoperative abdominal incision marks.
Surgical procedures are indicated to treat complications of Crohn’s disease such as obstructive stenosis, bleeding, fistula formation, perforation, growth retardation in children, and malignant changes. Cesarean section is routinely used; laparoscopic surgery is a recent advancement and has the following advantages over cesarean section.
I. Small trauma, fast recovery, small incision and relatively beautiful.
Second, less intestinal adhesions and other complications
Third, some studies have shown that there may be a relatively low recurrence rate
However, the difficulty of laparoscopic surgery is higher than that of cesarean surgery, and the requirements for surgical staff and equipment are high. After checking the literature, there are a few international reports on laparoscopic surgery for Crohn’s disease, but no specific reports in China. It seems that our technology is still more advanced.
How to make an early and successful diagnosis
The patient, Wang, was suffering from underage Crohn’s disease, which, due to the complexity and specificity of this disease, was an important reason why he was not correctly diagnosed and treated in other large and small hospitals for ten years; our hospital worked closely with multiple disciplines to successfully identify the cause of the disease that had been afflicting the patient for ten years, avoiding the continuation of painful misdiagnosis; parents and medical personnel concerned should consider Crohn’s disease when they encounter similar minors with recurrent abdominal pain and diarrhea combined with developmental delay that cannot be explained by other common diseases. When parents and medical personnel encounter recurrent abdominal pain and diarrhea in minors with developmental delays that cannot be explained by other common diseases, the possibility of Crohn’s disease should be considered and confirmed by endoscopic biopsy and small bowel imaging.
In view of the increasing incidence of Crohn’s disease in children or adolescents under 20 years of age and the tendency of the age of onset to be younger, the above experience should be taken seriously.