Chronic pancreatitis as presentation of Crohn’s disease in a child

Abstract

It is reported that a pancreatic disease may precede the diagnosis of inflammatory bowel disease (IBD) both in children and in adults. Idiopathic chronic pancreatitis, however, occasionally co-exists with the IBD, mainly at pediatric age. We report a case of a patient who progressively developed the features of a chronic pancreatitis, before the diagnosis of Crohn’s Disease (CD). Ten months after the onset of the first episode of pancreatitis the patient developed bloody diarrhea, mucus stools and biochemical findings of inflammation. The colonoscopy revealed a diffuse colitis without involvement of the last loop and the gastroscopy showed inflammation of the iuxta-papillary area. The histological findings confirmed the diagnosis of CD that involved the colon and the duodenum. In conclusion, in children the idiopathic chronic pancreatitis may be an unusual presentation of CD. Thus, if other known cause of chronic pancreatitis are not found, a not invasive work up to exclude the IBD should be warranted. An early coincidental diagnosis of the IBD may delay the progression of the pancreatic disease.

Keywords: Inflammatory bowel disease; Crohn’s Disease; Pediatric age; Bloody diarrhea; Pancreatic disease

Core tip: We report a cases of chronic pancreatitis associated with Crohn’s Disease (CD). We have not been able to find reports of this association in the pediatric medical literature. The present case suggests that in children the idiopathic chronic pancreatitis may be an unusual presentation of CD. Thus, if other known cause of chronic pancreatitis are not found, a not invasive work up to exclude the inflammatory bowel disease should be warranted. The early recognition of the CD, indeed, may help in delay the progression of the pancreatic disease.