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Colonic diverticulitis in children: A retrospective study of 16 patients

Hatakeyama, Tadashi Okata, Yuichi Miyauchi, Harunori Hisamatsu, Chieko Nakatani, Taichi Nakai, Yumiko Bitoh, Yuko 神戸大学

2021.12

概要

Background Pediatric colonic diverticulitis (CD) is a rare entity. This study aimed to investigate the clinical features of CD in children. Methods We performed a retrospective chart review of children aged ≤15 years who were diagnosed with CD in our institution from May 2006 to November 2016. Results Sixteen patients were diagnosed with CD. All CD cases were observed to be solitary cecal diverticulitis; 14 cases were detected using ultrasound and the other two cases were diagnosed by computed tomography. Five patients were male (31.3%), and the median age was 12 years (range, 8–15 years). Initial symptoms were fever (temperature >38°C) in six (37.5%) patients, right lower quadrant abdominal pain in 16 (100%), anorexia in eight (50%), and nausea / vomiting in five (31.3%). A patient experienced persistent constipation; however, diarrhea was not observed as a clinical symptom in any patient. The median duration from symptom onset to admission was 1 day (range, 0–4 days), and the median length of hospital stay was 6 days (range, 4–10 days). All CD cases were treated with intravenous antibiotics. The median follow-up period was 90 months (range, 37–163 months), and during this period, recurrence of CD was observed in three (18.8%) patients. At recurrence, antibiotics were administered in all cases. Conclusions In this study, all cases of CD were solitary cecal diverticulitis, and ultrasound was useful for the diagnosis of cecal diverticulitis in children. Non-operative treatment should be recommended as an initial treatment for CD in children.

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参考文献

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Colonic diverticulitis in children

Figure legends

Figure 1. Ultrasonography for cecal diverticulitis

An outpouching diverticulum (arrow heads) from the lateral wall of the cecum (white

arrows) with markedly increased echogenicity of the surrounding fat (a) and increase in

arterial blood flow exhibiting a ring shape on color Doppler (b).

13

Table. Patient demographics, symptoms and findings of imaging studies.

No

Age

Sex

Onset

Symptoms

US/CT

US or CT Findings

(y)

(days)

Fever

Pain

Anorexia

Vomit

Thick

Vascular flow

Ascites

Fat

Lymph

Stone

Antibiotics

Recurrence

(days)

(months)

Abscess

-ness

11

13

12

US

US

US

US

11

US

13

US

CMZ-3

US

CMZ-4

CT(E)

15

US

10

14

US

11

12

US

12

12

US

13

12

US

CMZ-2→TAZ-6

14

13

CT

CMZ-8

15

14

US

CMZ-5→SBTPC-3

16

12

US

CMZ-3→FOM-7

CMZ-5

CMZ-6

CMZ-2→TAZ-7

CMZ-7

CMZ-5

CMZ-5

TAZ-15

Onset: duration from onset of symptoms to admission, Pain: right quadrant abdominal pain, E: enhanced, Thickness: thickness of diverticulum wall, Vascular Flow: increased vascular flow of

diverticulum wall, Fat: increased echo brightness of surrounding fatty tissue, Lymph: lymph node swelling, Stone: feces stone,

CMZ: cefmetazole, TAZ: tazobactam / piperacillin, SBT-ABPC: sulbactam / ampicillin, FOM: fosfomycin

CMZ-4

CMZ-4

CMZ-6

17

18

...

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