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A 4-year-old girl with chronic nonspecific multiple ulcers of the small intestine diagnosed by double-balloon endoscopy

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Abstract

We present the youngest patient reported to date with chronic nonspecific multiple ulcers of the small intestine (CNSU) diagnosed by double-balloon endoscopy (DBE). A 3-year-old girl was referred to our department with a 2-year history of iron-deficiency anemia. Failure to thrive and hypoproteinemia were also noted, and stool occult blood tests had been persistently positive. However, the C-reactive protein level and erythrocyte sedimentation rate were not elevated. Esophagogastroduodenoscopy and double-contrast enema revealed no abnormality in the colon and terminal ileum. Retrograde DBE was performed when the patient was 4 years old. Linear ulcerations arranged in an oblique or circular pattern were present at 3 sites between 55 and 65 cm from the ileocecal valve. Microscopic examination showed nonspecific inflammatory changes, and no granuloma was present. Based on the clinical and endoscopic findings, the patient was diagnosed as having CNSU. The youngest previously reported patient with CNSU was 7 years old, whereas our present patient was diagnosed at the age of 4 years. In pediatric cases of obscure gastrointestinal bleeding, it may be necessary to be aware of small bowel disease.

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Acknowledgments

Advice for diagnosis of endoscopy findings: Fumihito Hirai, Assistant Professor, Department of Gastroenterology, Fukuoka University Chikushi Hospital. Pathological diagnosis: Masanori Tanaka, Chief, Clinical Laboratory Department, Hirosaki Municipal Hospital.

Disclosures

Conflict of Interest: Hisayuki Tsukahara, Hideki Kumagai, Tomonori Yano and Shun-ichi Maisawa that they have no conflict of interest.

Human and Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent: Informed consent was obtained from the patient’s parents.

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Authors and Affiliations

  1. Department of Pediatrics, Kazuno Kousei Hospital, Kazuno, Japan

    Hisayuki Tsukahara

  2. Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan

    Hideki Kumagai

  3. Department of Gastroenterology, Jichi Medical University, Shimotsuke, Japan

    Tomonori Yano

  4. Morioka Children’s Hospital, Morioka, Japan

    Shun-ichi Maisawa

  5. 18 Aza-Mukaihata, Hanawa, Kazuno-shi, Akita, 018-5201, Japan

    Hisayuki Tsukahara

Authors
  1. Hisayuki Tsukahara
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  2. Hideki Kumagai
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  3. Tomonori Yano
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  4. Shun-ichi Maisawa
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Correspondence to Hisayuki Tsukahara.

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Tsukahara, H., Kumagai, H., Yano, T. et al. A 4-year-old girl with chronic nonspecific multiple ulcers of the small intestine diagnosed by double-balloon endoscopy. Clin J Gastroenterol 7, 144–147 (2014). https://doi.org/10.1007/s12328-014-0466-6

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  • DOI: https://doi.org/10.1007/s12328-014-0466-6

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