Acute surgical presentation of Crohn's disease in a 13-year-old: An interdisciplinary approach. Clinical case

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Abstract

In pediatric surgery, the management of intestinal complications in children with Crohn's disease (CD) remains a significant and complex challenge. Currently, there are no established indications for surgical intervention in refractory CD, nor are there clear guidelines regarding the timing, type of surgery, or optimal surgical approach. Recent advances in pediatric video endoscopic surgery have facilitated the adoption of modern endosurgical techniques for treating coloproctological complications in CD. This article presents a rare clinical case of penetrating CD in a 13-year-old patient, illustrating an acute surgical presentation that mimicked other pathologies. The case highlights the predominance of nonspecific chronic symptoms, such as weakness, with only mild intestinal manifestations, and demonstrates the variability of abdominal syndromes that may resemble myalgia or symptoms observed during acute respiratory viral infections.

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About the authors

Anastasia S. Koshurnikovа

Bashlyaeva Children's City Clinical Hospital

Author for correspondence.
Email: saller03@mail.ru
ORCID iD: 0000-0002-2306-9743

Cand. Sci. (Med.)

Russian Federation, Moscow

Ismail M. Osmanov

Bashlyaeva Children's City Clinical Hospital

Email: saller03@mail.ru
ORCID iD: 0000-0003-3181-9601

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Ekaterina V. Sсorobogatova

Bashlyaeva Children's City Clinical Hospital; Russian Medical Academy of Continuous Professional Education

Email: saller03@mail.ru
ORCID iD: 0009-0003-9227-9378

Cand. Sci. (Med.)

Russian Federation, Moscow; Moscow

Svetlana N. Borzakova

Russian Medical Academy of Continuous Professional Education

Email: saller03@mail.ru
ORCID iD: 0000-0001-5544-204X

Cand. Sci. (Med.)

Russian Federation, Moscow

Dmitry A. Pykhteev

Bashlyaeva Children's City Clinical Hospital

Email: saller03@mail.ru
ORCID iD: 0000-0001-7432-7004

Cand. Sci. (Med.), Assoc. Prof.

Russian Federation, Moscow

Elena I. Epifanova

Bashlyaeva Children's City Clinical Hospital

Email: saller03@mail.ru
ORCID iD: 0000-0003-3795-3203

MD, Pathol.

Russian Federation, Moscow

Olga V. Koren'kova

Bashlyaeva Children's City Clinical Hospital

Email: saller03@mail.ru
ORCID iD: 0000-0001-6569-7409

MD, Ped. Surgeon

Russian Federation, Moscow

Irina N. Zakharova

Russian Medical Academy of Continuous Professional Education

Email: saller03@mail.ru
ORCID iD: 0000-0003-4200-4598

D. Sci. (Med.), Prof.

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Ultrasound of hollow viscera.

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3. Fig. 2. Ultrasound of hollow viscera (aperistaltic tubular structure).

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4. Fig. 3. Endoscopic image during laparoscopic surgery. Abscess draining.

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5. Fig. 4. Endoscopic image during laparoscopic surgery: a – terminal ileum; b – identified ileal perforation.

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6. Fig. 5. Photo of a patient with an ileostomy.

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7. Fig. 6. Photo of the gross specimen: a – terminal ileum. A fixed fragment of the intestine, 9.0 cm long, the margins of the resection are not marked; b – cross-section of the ileum.

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8. Fig. 7. Microphotograph of histological specimen: a – lymphoid infiltrates and granulations in the serous membrane of the small intestine; b – granuloma of epithelioid and Pirogov-Langhans giant cells; c – deep fissure ulcer of the small intestine. The wall of the ulcer is formed by a layer of granulation tissue.

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9. Fig. 8. Endoscopic image during esophagogastroduodenoscopy: a – the gastric fundus in the inversion examination; b – the duodenum.

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10. Fig. 9. Endoscopic image of the colon mucosa with diffuse hyperemia and punctate erosions.

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