Errors in the diagnosis of inflammatory bowel disease in a 2-year-old child as a clinical case example

Abstract

Inflammatory bowel disease occurs in approximately 4–5 children per 100,000, and its course is more severe than in adults. Inflammatory bowel disease is predominantly diagnosed in boys aged 11–17 years, but data on the incidence of very early onset (before 6 years of age) remain contradictory. The gold standard for diagnosing inflammatory bowel disease is endoscopic examination with colon biopsy, but invasive methods are avoided in young children due to technical difficulties and risks, and often due to parental refusal. One possible explanation for the delay in diagnosing inflammatory bowel disease is the nonspecific nature of its symptoms (abdominal pain, blood in the stool, diarrhea, perirectal abscesses), which can easily be confused with more common conditions such as irritable bowel syndrome or polyps. Nonspecific symptoms, complicating the diagnostic search, lead to late diagnosis and delayed proper treatment. The most serious complication of the long-lasting untreated disease is intestinal strictures, which over time lead to a violation of the passage of intestinal contents and require surgical intervention, which negatively affects the functions of the intestine (absorption and motor) and leads to the worsened quality of life.

The article describes a clinical case of inflammatory bowel disease in a child aged 2 years 10 months, admitted to Filatov City Clinical Hospital in Moscw with complaints of blood in the stool. Only 3 months after the initial visit to doctors, colonoscopy was made which showed endoscopic and morphological signs of inflammatory bowel disease. After a number of conservative measures, the stool became semi-formed, without signs of bleeding. The child was discharged in a satisfactory condition with recommendations to continue symptomatic therapy under the supervision of a district gastroenterologist and pediatrician.

Thus, underestimation of inflammatory bowel disease as a possible diagnosis at an early age threatens the transition of an acute condition to a chronic one with its subsequent deterioration. Increasing the alertness of outpatient doctors, if a child has non-specific complaints, will allow timely diagnostics and selection of the adequate treatment.

Keywords

case report / inflammatory bowel disease / colonoscopy / children

References

[1] Kelsen JR, Russo P, Sullivan KE. Early-onset inflammatory bowel disease. Immunol Allergy Clin North Am. 2019;39(1):63–79. doi: 10.1016/j.iac.2018.08.008

[2] Long D, Wang C, Huang Y, et al. Changing epidemiology of inflammatory bowel disease in children and adolescents. Int J Colorectal Dis. 2024;39(1):73. doi: 10.1007/s00384-024-04640-9

[3] Seyedian SS, Nokhostin F, Malamir MD. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life. 2019;12(2):113–122. doi: 10.25122/jml-2018-0075

[4] Khavkin AI, Naletov AV, Marchenko NA. Inflammatory bowel diseases in children: modern achievements in diagnosis and therapy. Russian Journal of Gastroenterology, Hepatology, and Coloproctology. 2023;33(6):7–15. doi: 10.22416/1382-4376-2023-33-6-7-15 EDN: LDFLGQ

[5] M’Koma AE. Inflammatory bowel disease: Clinical diagnosis and surgical treatment-overview. Medicina (Kaunas). 2022;58(5):567. doi: 10.3390/medicina58050567

[6] Zhou X, Kern I, Rothe U, et al. Growth development of children and adolescents with inflammatory bowel disease in the period 2000-2014 based on data of the Saxon pediatric IBD registry: A population-based study. BMC Gastroenterol. 2024;24(1):25. doi: 10.1186/s12876-023-03088-5

[7] Agrawal M, Spencer EA, Colombel JF, Ungaro RC. Approach to the management of recently diagnosed inflammatory bowel disease patients: A user’s guide for adult and pediatric gastroenterologists. Gastroenterology. 2021;161(1):47–65. doi: 10.1053/j.gastro.2021.04.063

[8] Lv H, Li HY, Zhang HN, Liu Y. Delayed diagnosis in inflammatory bowel disease: Time to consider solutions. World J Gastroenterol. 2024;30(35):3954–3958. doi: 10.3748/wjg.v30.i35.3954

[9] Shazib MA, Byrd KM, Gulati AS. Diagnosis and management of oral extraintestinal manifestations of pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2022;74(1):7–12. doi: 10.1097/MPG.0000000000003302

[10] Shivashankar R, Lichtenstein GR. Mimics of inflammatory bowel disease. Inflamm Bowel Dis. 2018;24(11):2315–2321. doi: 10.1093/ibd/izy168

RIGHTS & PERMISSIONS

Eco-Vector