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Virtual Pediatric Hospital: Paediapaedia: Chron Disease Paediapaedia: Gastrointestinal Diseases

Crohn Disease

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Abdominal pain and diarrhea which is rarely bloody, unlike in ulcerative colitis. Twenty percent of all cases present in children, and can present as young as 7 years. Systemic manifestations include fever, anorexia, weight loss, growth failure and arthritis.

Etiology/Pathophysiology:
Etiology is unknown. Have transmural inflammation of the bowel wall with multiple longitudinal and transverse ulcerations of the mucosa forming a cobble stone pattern with skip areas. May affect any site in the GI tract, but the small bowel is the primary disease site in children, usually with ileocolic involvement. Eleven percent have isolated colonic disease, and total colonic disease is rare. Fistulas are common because the disease is transmural and are often seen in the perianal region.Carcinoma is unusual.

Pathology:
Transmural inflammation characterized by scattered granulomas containing mononuclear and multinucleated giant cells seen in bowel wall and adjacent lymphnodes.

Imaging Findings:
Small bowel involvement is characterized by hypermotility and thickened and coarsened mucosal folds. Seventy percent have small bowel disease, and the terminal ileum is the most commonly involved site in the GI tract. The earliest manifestations in the colon are small irregular nodules with accentuation of haustral markings. Later, "cobble stoning" from deep crisscross ulcers which may penetrate the bowel wall are seen. The rectum is normally spared. There can be multicentric involvement, with normal areas in between, so called "skip lesions." Strictures can develop in chronic disease along with fistulas.

DDX:

References:

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