Ischemic small bowel strictures in a case of incomplete Kawasaki disease

Beiler, H. A.; Schmidt, Klaus G.; Herbay, A. von; Löffler, W.; Daum, R.

doi:10.1053/jpsu.2001.22311

Cited by 28 publications

(27 citation statements)

References 19 publications

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“…20,21 A clue to the development of this complication, as demonstrated in the present case, is the presence of persistent vomiting during the course of the illness, which is uncommon in KD. In contrast to those who develop mechanical bowel obstruction secondary to ischemic strictures, in which vomiting generally appears 2 to 4 weeks after the acute illness, [13][14][15][16] vomiting in pseudoobstruction tends to be seen early. 2,20,22 The pathogenesis of pseudoobstruction in KD is felt to relate to mesenteric artery vasculitis with bowel ischemia and associated dysfunction of the myenteric plexus 20,22 ; however, in those cases in which mesenteric vessel imaging has been performed, no abnormalities have been found, 20 suggesting probable small vessel involvement.…”

Section: Discussionmentioning

confidence: 89%

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Intestinal Pseudoobstruction in Kawasaki Disease

Akikusa

Laxer

Friedman³

2004

Pediatrics

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ABSTRACT. Intestinal pseudoobstruction is an uncommon but important manifestation of Kawasaki disease. Its occurrence at the onset or during the course of the disease may confuse the clinical picture and cause delay in diagnosis and treatment. This delay may be responsible for the high rate of coronary artery abnormalities that have been reported in patients with this complication. We suggest that Kawasaki disease be considered in the differential diagnosis of any child presenting with intestinal pseudoobstruction and fever without definable cause.

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Section: Discussionmentioning

confidence: 89%

“…11 Surgical complications in KD are well recognized. Complications reported in the literature include bowel infarction, 12 bowel obstruction related to ischemic strictures, [13][14][15][16] focal colitis, 17 and peripheral gangrene. 12,13,18,19 Intestinal pseudoobstruction has been reported to occur in up to 2% to 3% of children with KD.…”

Section: Discussionmentioning

confidence: 99%

Intestinal Pseudoobstruction in Kawasaki Disease

Akikusa

Laxer

Friedman³

2004

Pediatrics

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“…Although most studies have suggested that conservative treatment should be adequate in IOP cases [7], many patients have received surgical intervention prior to recognition of KD [1,6]. In this case, the presence of a fibrin coating on the bowel wall and the necrosis of the lymph nodes suggests ischemic change and the likelihood that further surgical procedures would be necessary [8]. In addition, the fever was observed to have subsided dramatically after bowel decompression.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Kawasaki Disease with Intestinal Pseudo-obstruction

Lin

Chang

et al. 2010

Indian J Pediatr

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A 5-year-old boy suffering from abdominal pain accompanied by a fever of up to 39.5°C for 2 days was admitted to the hospital. Although Flomoxef was administered following admission, the boy's fever persisted and abdominal distension gradually worsened. On the 4th day, dry lips, red eyes and a strawberry tongue were noted. An echocardiogram revealed pericoronary enhancement with mild mitral valve regurgitation and a small degree of pericardial effusion, characteristics compatible with Kawasaki disease. Although intravenous immunoglobulin was administered, the fever and abdominal distension persisted. On the 8th day, a pediatric surgeon was consulted and an exploratory laparotomy was arranged. During the operation, intestinal pseudo-obstruction and fibrin coatings around the intestine near the splenic flexure were found. A colostomy was performed for decompression of the dilated bowel and a biopsy of the lymph node surrounding the splenic flexure was taken. The fever subsided dramatically after decompression of the bowel and the recovery course was uneventful. The pathologic report revealed necrotic lymphadenitis. We report this rare case and review the literature.

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“…La cirugía debe ser reservada para aquellos pacientes con cuadro obstructivo intestinal completo y signos peritoneales (43). Hay casos reportados de intususcepción (1,44) y también de estenosis del yeyuno (45,46). En los casos que no responden al tratamiento convencional en la Enfermedad de Kawasaki se ha empleado una combinación de altas dosis de corticosteroides con Cyclosporina A (47).…”

Section: Discusionunclassified

“…En resumen, este caso como el de otros, la sintomatología gastrointestinal (1,43,44,45,46) desvió nuestra atención hacia diagnósticos que involucraban al aparato digestivo. A pesar de la presencia de fiebre, del compromiso de los labios, de la lengua, el rash y la aparición anticipada del aumento de volumen de la falanges distales de las manos, signos todos ellos presentes en la Enfermedad de Kawasaki, el síntoma prevalente y el que más preocupaba era el dolor abdominal.…”

Section: Discusionunclassified

Enfermedad de Kawasaki: un caso con pseudo-obstrucción intestinal y aneurisma gigante

Tori¹,

Galgani²

2015

Rev Med Hered

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SUMMARYWe present a rare association of Kawasaki disease in a two year old boy presenting with fever, a morbiliform rash and clinical signs of intestinal pseudo-obstruction. Our patient subsequently developed a giant aneurysm of the right coronary artery complicated with thrombosis. He presented fever again 48 hours after the first dose of Immunoglobulin and needed a second one with good results. These patients with giant coronary aneurysms have a greater risk of developing stenosis and myocardial infarction, and require anticoagulant therapy, frequent stress scans and coronary angiographies. Those who developed less severe disease need only antiplatelet therapy and less frequent cardiovascular tests. Patients with a normal echocardiogram after the acute phase of the disease are not treated. The long-term prognosis of this disease is uncertain, especially regarding the possible association with coronary disease in adult life. (Rev Med Hed 2002; 13: 114-122).KEY WORDS: Kawasaki, mucocutaneous lymph node syndrome, vasculitis, pseudoobstruction, coronaryaneurysms. INTRODUCCIÓNPresentamos a un paciente varón de dos años de edad con Enfermedad de Kawasaki y secuelas cardiovasculares. Se presentó como un cuadro febril, signos abdominales sugestivos de un cuadro suboclusivo intestinal y un rash morbiliforme en el cuerpo. Durante su evolución inmediata los tramos iniciales de las dos arterias coronarias principales fueron aumentando de tamaño hasta convertirse la arteria coronaria derecha en un aneurisma gigante de 9.7 mm de diámetro, que desarrolló un trombo aunque sin mayores complicaciones.Debido a su compromiso cardiovascular, nuestro paciente presenta un gran riesgo de desarrollar estenosis coronaria, razón por la cual tiene que ser evaluado periódicamente.A pesar que la Enfermedad de Kawasaki es una enfermedad poco común, sin embargo, su forma de presentación y los signos y síntomas que presenta, la hacen confundirse con otras enfermedades más usuales, lo que hace que se demore o no se haga el diagnóstico a tiempo y poder así evitar secuelas tan importantes como el aneurisma gigante que presentó este paciente a pesar que el diagnóstico fue hecho con prontitud. Caso Clínico:Paciente varón de 2 años de edad, con historia de fiebre alta, dolor abdominal y constipación. Se inicia con dolor abdominal difuso tipo cólico, dos días antes de su ingreso y que fué aumentando en intensidad en las 24 horas previas a su ingreso. No eliminaba flatos y no había

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Ischemic small bowel strictures in a case of incomplete Kawasaki disease

Cited by 28 publications

References 19 publications

Intestinal Pseudoobstruction in Kawasaki Disease

Intestinal Pseudoobstruction in Kawasaki Disease

Surgical Treatment of Kawasaki Disease with Intestinal Pseudo-obstruction

Enfermedad de Kawasaki: un caso con pseudo-obstrucción intestinal y aneurisma gigante

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