Enter your Email address:
Wolters Kluwer Health may email you for journal alerts and information, but is committed
to maintaining your privacy and will not share your personal information without
You currently have no recent searches
Wewer, V.1; Paerregaard, A.1; Faerk, J.2; Matzen, P.3
1Dept. of Pediatrics, Hvidovre Hospital, Hvidovre, 2Dept. of Pediatrics, Holbaek Hospital, Holbaek, 3Dept. of Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
Submitted by: firstname.lastname@example.org
Introduction: Duodenal strictures associated with Crohn’s disease (CD) may cause severe morbidity. In adult patients with obstructive symptoms endoscopic dilation with hydrostatic balloons is a therapeutic option to avoid intestinal surgery. Reports of this treatment in children and adolescents are few.
Methods: A 16 years old girl was admitted with weight loss of 4 kg, nausea, epigastric pain and explosive vomiting during three months. Diagnostic work-up revealed elevated serum levels of CRP, orosomucoid, leucocytes and pancreatic fraction of amylase, a positive ASCA and low albumin. Upper GI endoscopy disclosed a normal stomach, pylorus and duodenal bulb, but a severe prestenotic dilation in the 2nd part of duodenum due to a stricture at the level of the papilla of Vater. Duodenal biopsies revealed acute and chronic inflammation. Coloileoscopy showed inflammation of terminal ileum. Biopsies from ileum, colon ascendens, transversum and descendens showed inflammation with granulomas. MRCP was normal. After failed medical therapy another upper GI endoscopy was performed to evaluate the possibility of endoscopic dilatation. Two 8–9 mm strictures were seen in 2nd part of duodenum together with Crohn’s ulcerations. The papilla of Vater could not be seen.
Results: Treatment: Corticosteroids were given together with elemental nutrition in a four-weeks period with considerable symptomatic relief. However, symptoms relapsed after a few weeks. During the first year of disease several corticosteroid courses were needed without induction of remission, and azathioprine was given. MRCP then revealed a slightly dilated ductus choledochus a normal ductus pancreaticus terminating in the stenotic duodenum.
Within 6 months a series of five endoscopic dilations with Rigiflex balloons was performed (video illustrated). Corticosteroids were injected in the stricture at the 4rd dilatation. A lumen of 20 mm was achieved. The patient had symptomatic relief, a weight gain of 1.2 kg during the six months period of dilatation and corticosteroids were discontinued.
Conclusion: Relief of symptoms and weight gain were established by repeated balloon dilation of the duodenal strictures.
© 2004 Lippincott Williams & Wilkins, Inc.
Colleague's E-mail is Invalid
Your Name: (optional)
Separate multiple e-mails with a (;).
Thought you might appreciate this item(s) I saw at Journal of Pediatric Gastroenterology and Nutrition.
Send a copy to your email
Your message has been successfully sent to your colleague.
Some error has occurred while processing your request. Please try after some time.
An Existing Folder
A New Folder
The item(s) has been successfully added to "".
Login with your LWW Journals username and password.
Username or Email:
Enter and submit the email address you registered with. An email with instructions to reset your password will be sent to that address.
Link to reset your password has been sent to specified email address.
What does "Remember me" mean?
By checking this box, you'll stay logged in until you logout. You'll get easier access to your articles, collections,
media, and all your other content, even if you close your browser or shut down your
To protect your most sensitive data and activities (like changing your password),
we'll ask you to re-enter your password when you access these services.
What if I'm on a computer that I share with others?
If you're using a public computer or you share this computer with others, we recommend
that you uncheck the "Remember me" box.
Save my selection
Visit JPGN.org on your smartphone. Scan this code (QR reader app required) with your phone and be taken directly to the site.