Neuroendocrine tumors (NET) of the gastrointestinal tract and pancreas are extremely rare in the pediatric population and limited data is available. In most cases, NET of the gastrointestinal tract in children are located in the appendix. Pancreatic NET are a small but partially distinct group of the gastrointestinal neuroendocrine neoplasms. The most common in this group are insulinomas; however, in some research, the gastrinoma type neoplasms are perceived to be most common in children. This study reviews the typical clinical presentation, appropriate diagnostics, staging, and treatment of these uncommon neoplasms. It is important to know the epidemiology and symptomatology in this age group despite the fact that the majority of physicians treating the youngest patients will never have to deal with it. This will facilitate an early diagnosis in case of symptoms that may suggest neuroendocrine cancer. It appears necessary to create harmonized recommendations regarding the diagnosis, treatment and post-treatment follow-up for pediatric patients.
Introduction: Lower gastrointestinal bleeding (LGIB) is not a rare clinical problem in children. The aetiology of LGIB varies according to age. Likewise, experiences in different countries reflect the disparities in the frequency of various causes of LGIB in children. Although some cases can be diagnosed clinically, choosing the appropriate diagnostic methods in children is challenging. The aim of the study was to determine the aetiology of LGIB in children and analyse the diagnostic procedures needed to make a diagnosis. Material and methods:The medical records of children with chronic LGIB admitted to the Paediatric Gastroenterology Department were reviewed. The diagnoses and diagnostic procedures were analysed according to age groups (< 5 with subgroups < 2 and 2-5, 5-10, and > 10 years old). Results: 227 patients were enrolled in the study. The most important causes of LGIB among all patients were constipation associated with anal fissures (36.6%) and inflammatory bowel disease (IBD) (33.5%). According to age groups, the main causes of LGIB were: up to 5 years old -constipation (39.62%) and food allergy (28.3%), in the youngest age subgroup up to 2 years old -food allergy (52.38%), between 5 and 10 years old -constipation (44%) and ulcerative colitis (14%), over 10 years old -IBD ulcerative colitis (36.29%), Crohn's disease (13.71%), and constipation (32.26%). Patients with IBD were more likely to have anaemia and weight loss. The level of faecal calprotectin was significantly elevated in children with IBD and colorectal polyps. Conclusions: Constipation is a common cause of LGIB in all age groups of children. Food allergy should be considered in infants and young children, but it is rarely seen in children over 5 years old. In children older than 5 years old, diagnostics for IBD should be carried out, especially in patients with weight loss, high levels of faecal calprotectin, and anaemia. Colorectal polyps and Meckel's diverticulum are less common causes of LGIB.
We present a case of a 17-year-old so far healthy and normally developing boy, who was admitted to our Department due to perianal fistulas persisting for three years. Previous diagnostic procedures, including colonoscopy, failed to provide the diagnosis. No improvement was observed after repeated surgical interventions and oral antibiotic therapy. A suspicion of Crohn's disease was raised. Full diagnosis was performed: gastroscopy and colonoscopy with biopsy, magnetic resonance enterography, and pelvic magnetic resonance. Crohn's disease was diagnosed based on the overall clinical picture and laboratory findings. The aim of this paper was to emphasise the importance of early targeted diagnosis to avoid diagnostic delay and thus reduce the risk of complications. A general practitioner, who provides primary care and refers his patients for additional tests and consultations, plays a very important role in this process. Therefore, by describing the case of this young patient, we aimed to draw attention to some typical symptoms that may be the very first manifestations of chronic inflammatory bowel disease. The chronic or recurrent perianal lesions in an otherwise normally developing adolescent showing no other gastrointestinal symptoms should be a motivation for performing full diagnosis for Crohn's disease.
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