Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Perianastomotic ulceration presenting with long-term iron deficiency anemia and growth failure: A case report and review of the literature

장기간의 철 결핍 빈혈 및 성장부전으로 발현된 장문합부위 궤양 1예

  • Kang, Kyung Ji (Departments of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Eun Ha (Departments of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Jung, Eun Young (Departments of Pediatric Surgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Park, Woo-Hyun (Departments of Pediatric Surgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kang, Yu-Na (Departments of Pathology, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Ae Suk (Department of Pediatrics, Dongguk University College of Medicine) ;
  • Hwang, Jin-Bok (Departments of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine)
  • 강경지 (계명대학교 의과대학 소아과학교실) ;
  • 김은하 (계명대학교 의과대학 소아과학교실) ;
  • 정은영 (계명대학교 의과대학 소아외과학교실) ;
  • 박우현 (계명대학교 의과대학 소아외과학교실) ;
  • 강유나 (계명대학교 의과대학 병리학교실) ;
  • 김애숙 (동국대학교 의과대학 소아과학교실) ;
  • 황진복 (계명대학교 의과대학 소아과학교실)
  • Received : 2009.09.08
  • Accepted : 2009.10.19
  • Published : 2010.01.15
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Abstract

Perianastomotic ulceration (PAU) rarely occurs after small bowel resection in infancy. Since the understanding of its pathogenesis is incomplete, an effective method of treatment has not yet been discovered. We report the first case in Korea of a 10-year-old girl with chronic iron deficiency anemia (IDA) and growth failure who was diagnosed with PAU at colonoscopy. Seven years were required to identify the cause of IDA. After surgical resection and revision of anastomosis, a close follow-up is being conducted due to the risk of recurrence. Here, we also review reports on 25 pediatric patients with PAU derived from a search of the English-language literature and describe the clinical features of PAU along with the results of treatment.

장문합부위 궤양은 영유아기에 장 절단과 문합 후 발생하는 합병증으로 발병기전은 아직 정확하게 밝혀져 있지 않으며, 효과적인 치료법도 아직 개발되어 있지 않다. 저자들은 10세 된 여아의 만성 철 결핍 빈혈과 성장부전의 원인을 찾기 위하여 실시한 대장 내시경검사에서 장문합부위 궤양을 발견하고, 궤양이 있는 부위의 수술적 제거와 문합부 재교정 이후 증상의 호전을 경험하였기에 문헌고찰과 함께 국내 처음으로 보고하는 바이다. 장 절단술 후 증상의 발현이 늦어 진단이 어렵기 때문에 영유아기에 수술을 받은 환자의 경우 추적관찰을 통해 장문합부위 궤양의 발병 가능성을 예의주시해야 한다.

Keywords

References

  1. Couper RT, Durie PR, Stafford SE, Filler RM, Marcon MA, Forstner GG. Late gastrointestinal bleeding and protein loss after distal small-bowel resection in infancy. J Pediatr Gastroenterol Nutr 1989;9:454-60 https://doi.org/10.1097/00005176-198911000-00011
  2. Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, Engum SA. Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg 1998;133:490-7 https://doi.org/10.1001/archsurg.133.5.490
  3. Parashar K, Kyawhla S, Booth IW, Buick RG, Corkery JJ. Ileocolic ulceration: a long-term complication following ileocolic anastomosis. J Pediatr Surg 1988;23:226-8 https://doi.org/10.1016/S0022-3468(88)80727-9
  4. Sondheimer JM, Sokol RJ, Narkewicz MR, Tyson RW. Anastomotic ulceration: a late complication of ileocolonic anastomosis. J Pediatr 1995;127:225-30 https://doi.org/10.1016/S0022-3476(95)70299-7
  5. Ceylan H, Puntis JW, Abbott C, Stringer MD. Recurrent perianastomotic ileo/jejuno-colic ulceration. J Pediatr Gastroenterol Nutr 2000;30:450-2 https://doi.org/10.1097/00005176-200004000-00020
  6. Hamilton AH, Beck JM, Wilson GM, Heggarty HJ, Puntis JW. Severe anaemia and ileocolic anastomotic ulceration. Arch Dis Child 1992;67:1385-6 https://doi.org/10.1136/adc.67.11.1385
  7. Paterson CA, Langer JC, Cameron GS, Issenman RM, Marcaccio MJ. Late anastomotic ulceration after ileocolic resection in childhood [corrected]. Can J Surg 1993;36:162-4
  8. Bhargava SA, Putnam PE, Kocoshis SA. Gastrointestinal bleeding due to delayed perianastomotic ulceration in children. Am J Gastroenterol 1995;90:807-9
  9. Arnbjornsson E, Larsson LT. Ulceration in an ileocolic anastomosis treated with ranitidin. J Pediatr Surg 1999;34:1532-3 https://doi.org/10.1016/S0022-3468(99)90120-3
  10. Chari ST, Keate RF. Ileocolonic anastomotic ulcers: a case series and review of the literature. Am J Gastroenterol 2000;95:1239-43 https://doi.org/10.1111/j.1572-0241.2000.02016.x
  11. Weersma RK, Limburg AJ, Karrenbeld A, Koornstra JJ. Editor's quiz: iron deficiency anaemia 10 years after small bowel resection in infancy. Gut 2007;56:463, 488 https://doi.org/10.1136/gut.2006.097063
  12. Abdulhannan P, Puntis JW. Iron deficiency anaemia and perianastomotic ulceration as a late complication of ileal resection in infancy. Gut 2007;56:1478-9
  13. Challacombe DN, Richardson JM, Edkins S, Hay IF. Ileal blind loop in childhood. Am J Dis Child 1974;128:719-23