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10 January 2025 : Case report  USA

[In Press] Pediatric Crohn Disease Presenting as Isolated Acute Upper-GI Bleed: A Case Report

Unusual clinical course

Logan Norris1ABDEF, Parker Giroux ORCID logo2DE, Traci Jester2BDE, David P. Galloway2DE, Jeanine Maclin2DE, Stephanie Saaybi2DE, Benjamin Hill3DE, Mariangeles Medina Perez4DE, Chinenye R. Dike2ABDEF

DOI: 10.12659/AJCR.946099

Am J Case Rep In Press; DOI: 10.12659/AJCR.946099  

Available online: 2025-01-10, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
The incidence of Crohn’s disease (CD) has increased worldwide. Although common presenting symptoms of CD in children include abdominal pain, diarrhea, and rectal bleeding, it can also present atypically and can have extraintestinal manifestations. Isolated upper-gastrointestinal bleed as the only manifestation of CD with ileocolonic involvement is rare.
CASE REPORT
We describe the case of a previously healthy, 9-year-old boy who presented to the emergency department (ED) with isolated, acute-onset hematemesis. He was evaluated in the ED, and found to be hemodynamically stable, and hematemesis had resolved upon arrival to the ED. Therefore, he was placed on a proton pump inhibitor (PPI), and discharged with a close gastrointestinal clinic follow-up, which he missed. He returned to the ED 3 weeks later with another episode of hematemesis with hemodynamic instability requiring resuscitation and intensive care unit stay. He underwent an emergency esophagogastroduodenoscopy (EGD), which revealed a bleeding gastric ulcer in the fundus. Bleeding was controlled with epinephrine injection and application of hemostatic clips. Gastric biopsies revealed granulomas. Therefore, during his hospitalization, ileocolonoscopy was completed to rule out CD. Ileocolonoscopy showed left colonic edema with ulcers and terminal ileal ulcers with exudates. Histopathology revealed granulomas in these areas. Infliximab infusions were started during the hospitalization. He is currently receiving 10 mg/kg of infliximab every 4 weeks.
CONCLUSIONS
This case highlights the need for increased clinician awareness of atypical presentations of inflammatory bowel disease (IBD) and maintenance of a high index of suspicion when treating children and adolescents with acute GI bleed.

Keywords: Child; Crohn Disease; Gastrointestinal Hemorrhage; Hematemesis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923