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Case Reports in Gastrointestinal Medicine
Volume 2012, Article ID 152414, 4 pages
http://dx.doi.org/10.1155/2012/152414
Case Report

Colonic Perforation in a Child with Crohn's Disease: Successful Medical Treatment Rescues from Colectomy

1Department of Paediatrics, Unit of Gastroenterology, Digestive Endoscopy, Hepatology, and Care of the Child with Liver Transplantation, University Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy
2Department of Medical Diagnostic Sciences and Special Therapies, Institute of Radiology, University Hospital of Padova, Via Giustiniani 1, 35128 Padova, Italy
3Unit of Paediatrics, Central Hospital of Bolzano, Via Lorenz Böhler 5, 39100 Bolzano, Italy

Received 27 July 2012; Accepted 2 September 2012

Academic Editors: A. Imagawa, S. Karoui, and Y. Moriwaki

Copyright © 2012 Marco Gasparetto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The challenging treatment of penetrating paediatric Crohn’s disease (CD) involves pharmacological and surgical approaches. Despite a proved efficacy of anti-TNF agents for treatment of complex fistula, a large number of patients cannot achieve a complete healing and relapse during the followup. Aim. We report a paediatric case with CD and colonic perforation who was successfully treated with medical therapy only, including anti-TNFα. Case Presentation. During a colonoscopy performed on a 9-year-old girl with CD, a perforation occurred in correspondence of a fistula at the colonic splenic flexure. The formation of a collection was then detected (US, enteric-CT), as well as a fistula connecting the colon to the collection. The girl was kept fasting and treated with total parenteral nutrition and antibiotic therapy. Treatment with Infliximab was also started, and after the third dose a US control showed disappearance of the collection and healing of the enteric fistula. Parenteral nutrition was progressively substituted with enteral feeding, and no surgical treatments were needed. Discussion. In pubertal children with penetrating CD, the option of an efficacious medical treatment to avoid a major surgical approach on the bowel is to be aimed for growth improvement. This approach requires a strictly monitored long-term followup.