P49 Should children with coeliac disease be screened for type 1 diabetes mellitus in annual bloods? An audit of four years screening across four paediatric centres in England

Abstract

Results Four critically ill children (aged 1-14 years), requiring resection of ischaemic colon following sudden cardiovascular collapse, presented to our institutions over a 2-year period.Three had a preceding history of recent illness; the other had been well prior to out of hospital cardiac arrest. The 3 who were unwell experienced: headache (1), cough (1) and polyuria and polydipsia (1) for up to 2 weeks prior to hospital attendance. None had abdominal or gastrointestinal (GI) symptoms in their initial symptoms, although all but 1 developed GI upset during their rapid deterioration phase. Three had cardiac arrest before colectomy. All developed abdominal distension after resuscitation. All had significant derangement of blood sugar on monitoring. All 4 received inotropic support before surgery. All 4 had total colonic ischaemia diagnosed during surgical intervention and on histology report. There was no other underlying disease on histology (bowel was ganglionic). No infective organism was isolated (specifically all were negative for clostridium difficile). All 4 died due to multi organ failure. Summary and Conclusion From this case series we could not identify any specific condition that predisposed these 4 children to develop non occlusive mesenteric ischaemia and colonic injury. Therefore we could not clearly identify means of prevention.All 4 had a sudden deterioration over less than 24 hrs, and all received inotropes before developing abdominal distension. In addition, 3 out of 4 had cardiac arrest and return of circulation before colectomy. These would support the hypothesis of hypoperfusion/reperfusion injury.Even though all 4 patients had colonic resection as part of the resuscitation the outcomes were very poor leading to multi organ failure or cerebral ischaemia and death.