Constipation and Crohn’s Disease
Published on: 2019-09-17
Crohn’s disease is one of the most important chronic diseases that affect children and adolescents. Approximately 20-30% of all patients with Crohn’s disease present when they are younger than 20 years old. In addition to the common symptoms (diarrhoea, rectal bleeding, and abdominal pain), rarely children with large bowel involvement can present with constipation as the presenting symptom. It is a lifelong condition.
KeywordsCrohn’s disease; Rectal bleeding; Abdominal pain
Crohn’s disease is one of the most important chronic diseases that affect children and adolescents. Approximately 20-30% of all patients with Crohn’s disease present when they are younger than 20 years old. In addition to the common symptoms (Diarrhoea, Rectal bleeding, and Abdominal pain), rarely children with large bowel involvement can present with constipation as the presenting symptom. It is a lifelong condition.
A 13 year old girl presented with fever, rash, joint pains especially knees, rectal bleeding on couple of occasion and malaise for 10 days. She had on-going constipation. Her examination revealed pallor, erythema nodosum over shins, clubbing, and perianal skin tags. The rest of the systemic examination was unremarkable. Her CRP and ESR were sky-high. She was treated with IV antibiotics but her fever was persistent even after 2 weeks of antibiotics. Her Faecal calprotein was >6000 mg/Kg (Normal 0 – 50 mg/Kg). Small Bowel MRI showed colitis affecting the sigmoid and distal descending colon. The terminal ileum was also thick-walled and mildly inflamed, which was suggestive of inflammatory bowel disease. Her Upper GI endoscopy and colonoscopy was suggestive of chronic IBD (Crohn’s disease) she was treated with IV Methyl prednisolone, Intravenous metronidazole, and her symptoms improved. She was discharged home on oral prednisolone and metronidazole with outpatients follow up.
Signs and Symptoms of Crohn’s disease in children
The clinical presentation is primarily determined by the location and extent of the patient’s disease. Crohn’s disease with small intestine present with malabsorption, diarrhoea, growth retardation, abdominal pain, weight loss, anorexia. Colonic Crohn’s disease presents with skin tags, fissures, abscess, fistulae, painful defecation, rectal bleeding, perirectal pain, the most common extra intestinal manifestations are arthritis, arthralgia typically involving large joints e.g. knees and ankle. In this case she had knee joint pains. Constipation is a very rare presenting symptom.
Diagnosis is confirmed by colonoscopy with biopsy or upper GI endoscopy /oesophageal gastroduodenoscopy MRI is useful in the evaluation of pelvic and perianal disease. .Faecal Cal protein is usually increased. Full blood count may show hypochromic microcytic anaemia, iron deficiency anaemia, hypoalbuminaemia.
Abdominal pain, rectal bleeding, and diarrhoea are usual symptoms of inflammatory bowel disease, constipation is an unusual presentation.
- D'Aleo CM. Childhood Crohn's disease presenting as chronic constipation. Pediatr Med Chir. 2009; 31: 168-71.
- Ruemmele FM, G Veres, KL Kolho, A Griffiths, A Levine, JC Escher, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of paediatric Crohn's disease. J Crohn’s Colitis. 2014; 8: 1179-1207.