The patient is an 11-year-old girl who has been complaining of intermittent right lower
quadrant pain and diarrhea for the past year. She is small for her age. Her physical
examination indicates some mild right lower quadrant tenderness and fullness.
Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL)
Hematocrit (Hct), 28% (normal: 31%-43%)
Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL)
Meckel scan, No evidence of Meckel diverticulum
D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL)
120 min: 6 mg/dL (normal: >20 mg/dL)
Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in
Small bowel series, Constriction of multiple segments of the small intestine
The childís small bowel series is compatible with Crohn disease of the small intestine.
Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose
tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has
vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive
regimen, and her condition improved significantly. Unfortunately, 2 years later she
experienced unremitting obstructive symptoms and required surgery. One year after surgery,
her gastrointestinal function was normal, and her anemia had resolved. Her growth status
matched her age group. Her absorption tests were normal, as were her B12 levels. Her
immunosuppressive drugs were discontinued, and she is doing well.
Critical Thinking Questions
1. Why was this patient placed on immunosuppressive therapy? 2. Why was the Meckel scan ordered for this patient? 3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohnís
Disease? (always on boards)
4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?