Small bowel pseudo-obstruction in Kawasaki disease

Abstract

Between June 1977 and May 1986, 310 patients with Kawasaki disease were admitted to Shizuoka Children's Hospital. Among these patients, seven showed the symptoms of intestinal paralysis during the acute stage. We present three of these cases who showed typical intestinal pseudo-obstruction radiologically, and discuss the treatment of this type of intestinal involvement.

Intestinal Pseudoobstruction in Kawasaki Disease

“…12,13,18,19 Intestinal pseudoobstruction has been reported to occur in up to 2% to 3% of children with KD. 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.…”

“…In the report by Miyake et al, 20 7 of 310 patients with KD developed pseudoobstruction, of whom 5 were found to have coronary artery disease. Similarly Zulian et al 1 found a coronary artery aneurysm rate of 50% in their report of 10 children with KD presenting with a surgical abdomen, of whom 3 were felt to have intestinal pseudoobstruction.…”

“…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.…”

“…20 In 2 cases, IVIG was administered at the time of bowel symptoms (1 after a laparotomy), and in both there seems to have been a subsequent rapid resolution of symptoms. 1,2 In the present case, the intestinal symptoms had resolved with conservative management by the time the child was recognized as having KD and given IVIG.…”

“…Finally, Fang et al 2 report on 1 child who developed coronary artery abnormalities after presenting with predominant symptoms of fever, abdominal distension, and vomiting. It is unclear whether these outcomes reflect the delay that may occur in recognizing and treating these children or whether, as has been suggested by some, 1,20 it is a marker of a more significant vasculitis in those who develop this complication.…”