A 4-year-old girl with chronic nonspecific multiple ulcers of the small intestine diagnosed by double-balloon endoscopy
2014
We present the youngest patient reported to date with chronic nonspecific multiple ulcers of the small intestine (CNSU) diagnosed by double-balloon endoscopy (DBE). A 3-year-old girl was referred to our department with a 2-year history of
iron-deficiency anemia.
Failureto
thriveand
hypoproteinemiawere also noted, and
stool occult blood testshad been persistently positive. However, the C-reactive protein level and
erythrocyte sedimentation ratewere not elevated.
Esophagogastroduodenoscopyand double-contrast
enemarevealed no abnormality in the colon and
terminal ileum. Retrograde DBE was performed when the patient was 4 years old. Linear ulcerations arranged in an oblique or circular pattern were present at 3 sites between 55 and 65 cm from the
ileocecal valve. Microscopic examination showed nonspecific inflammatory changes, and no granuloma was present. Based on the clinical and endoscopic findings, the patient was diagnosed as having CNSU. The youngest previously reported patient with CNSU was 7 years old, whereas our present patient was diagnosed at the age of 4 years. In pediatric cases of obscure
gastrointestinal bleeding, it may be necessary to be aware of small bowel disease.
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