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Coloscopie et maladie de Crohn de l’enfant: analyse d’une série de 30 cas

Colonoscopy and crohn’s disease in children: a study of 30 cases

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Acta Endoscopica

RÈSUMÈ

74 coloscopies ont été faites chez 30 malades (15 garçons, 15 filles, âge moyen 13 ans) souffrant de maladie de Crohn (M. C.). La topographie des lésions a été la suivante: colique dans 8 cas, iléo-colique dans 13 cas, associée deux fois à une atteinte diffuse duodéno-jéjunale et une fois à une localisation œsophagienne; iléale exclusive dans 6 cas; jéjuno-iléale dans 3 cas Au total, une colite granulomateuse isolée ou associée à une autre localisation existait dans 21 cas (70 %). 19 ont été visualisées endoscopiquement (90 %). 8 fois, il s’agissait de pancolites où seul le rectum en tout ou partie était indemne, 11 fois de colites segmentaires uni ou pluri focales (6 cas) le plus souvent bipolaires. Macroscopiquement, les lésions observées ne diffèrent pas de celles observées chez l’adulte: ulcérations aphtoïdes (17 cas); macro-ulcérations (6 cas); ulcérations superficielles moins évocatrices (2 cas); atteinte nodulaire hémi-sphérique sous-muqueuse (8 cas); pseudo-polypes inflammatoires (10 cas); sténose colique (3 cas). Les biopsies coliques en côlon pathologique ont montré dans 42 % des cas un granulome épithélioïde. Au total, la coloscopie avec biopsies multiples et étagées occupe une place privilégiée dans la prise en charge diagnostique et évolutive des M. C. Elle se substitue, pour nous, sauf à la phase initiale d’évaluation au lavement baryté.

Summary

74 colonoscopies were carried out on 30 patients (15 boys and 15 girls, on average 13 years old) with Crohn’s disease (C. D.). The topography of the lesions was the following: colic in 8 cases, ileo-colic in 13 cases, associated on 2 occasions to diffuse affection of jejunoduodenal region and on one occasion associated to esophagus lesions; solely ileal in 6 cases; jejuno-ileal in 3 cases. A granulomatous colitis either on its own or associated to lesions of other regions existed in 21 cases (70 %). 19 were visualized by endoscopic examination (90 %). These included 8 cases of pancolitis in which the rectum was completely or partly lesion, free and 11 cases of uni or multifocal (6 cases) but more often bipolar segmentary colitis. Macroscopically, the lesions observed do not differ from those seen in adults: aphtous ulcérations (17 cases); large ulcérations (6 cases); less obvious superficial ulcérations (2 cases); nodular inflammatory pseudo-polyps (10 cases); lesions of the submucosa giving a nodular aspect (8 cases); colic stenosis (3 cases). The biopsy samples of the colon showed in 42 % of cases the presence of epithelioid granuloma. We conclude that colonoscopy with multiple biopsies holds an important role in diagnosis and surveillance of C. D. We feel that it can replace barium enema examination except in initial stages of evaluation.

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Author notes

  1. J. F. Mougenot

    Present address: Service de Gastroentérologie, Nutrition pédiatrique, Hôpital Trousseau, avenue du Dr A. Netter 26, 75012, Paris, France

Authors and Affiliations

  1. Service de Gastroentérologie, Nutrition pédiatrique, Hôpital Trousseau, avenue du Dr A. Netter 26, 75012, Paris, France

    J. Navarro

  2. Laboratoire Central d’Anatomie-Pathologie de l’Hôpital Trousseau, Paris, France

    L. Boccon-Gibod

  3. Laboratoire Central d’Anatomie-Pathologie, France

    E. Sonsino

Authors
  1. J. F. Mougenot
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  2. L. Boccon-Gibod
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  3. E. Sonsino
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  4. J. Navarro
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Mougenot, J.F., Boccon-Gibod, L., Sonsino, E. et al. Coloscopie et maladie de Crohn de l’enfant: analyse d’une série de 30 cas. Acta Endosc 14, 291–295 (1984). https://doi.org/10.1007/BF02963101

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