Клинический случай язвенного колита, осложненного стенозом прямой кишки, у ребенка 14 лет

Римская А.М., Самолыго И.С., Лим Ю.К., Яблокова Е.А., Горелов А.В. Клинический случай язвенного колита, осложненного стенозом прямой кишки, у ребенка 14 лет. Педиатрия. Consilium Medicum. 2025;1:96–100. DOI: 10.26442/26586630.2025.1.203205

© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.

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Rimskaya AM, Samolygo IS, Lim YuK, Yablokova EA, Gorelov AV. A clinical case of ulcerative colitis complicated by rectal stenosis in a 14-year-old child. Case report. Pediatrics. Consilium Medicum. 2025;1:96–100. DOI: 10.26442/26586630.2025.1.203205

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Аннотация

К воспалительным заболеваниям кишечника (ВЗК) относятся 2 основные нозологии – язвенный колит (ЯК) и болезнь Крона (БК). Несмотря на осведомленность специалистов, изученность патогенеза, высокое развитие диагностики, остаются пациенты, у которых клиническая, эндоскопическая и гистологическая картина не соответствуют в полной мере одному из заболеваний, что определяется как недифференцируемый колит. Впоследствии часть этих случаев верифицируется как ЯК или БК, однако другие пациенты длительно наблюдаются с неопределенным диагнозом. Тем не менее дифференциальная диагностика крайне важна для выбора терапевтической тактики, оценки рисков хирургического лечения и прогноза развития колоректального рака. Цель публикации – демонстрация сложностей дифференциальной диагностики ЯК и БК у ребенка со стенозом прямой кишки. В приведенном наблюдении у девочки с ЯК низкий комплаенс привел к значительным погрешностям в традиционных схемах терапии, развитию осложнений, необратимо изменяющих анатомическое строение толстой кишки и затрудняющих обследование, имитирующих течение стенозирующей БК. Клинический случай подчеркивает необходимость создания более детальных критериев дифференциальной диагностики, с разработкой дополнительных терапевтических алгоритмов, с более ранним назначением препаратов генно-инженерной биологической терапии как изменяющих патоморфоз заболевания.

Ключевые слова: воспалительные заболевания кишечника, язвенный колит, болезнь Крона, дифференциальная диагностика, стеноз прямой кишки

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Inflammatory bowel diseases (IBD) include two main entities: ulcerative colitis (UC) and Crohn's disease (CD). Despite the awareness of specialists, the knowledge of pathogenesis, and advances in diagnostics, there are still patients in whom the clinical, endoscopic, and histological presentation does not fully correspond to one of the diseases, which is defined as undifferentiated colitis. Subsequently, some of these cases are verified as UC or CD; however, other patients are followed up for a long time with an uncertain diagnosis. Nevertheless, differential diagnosis is crucial for the choice of therapeutic tactics, risk assessment of surgical treatment, and prognosis of colorectal cancer. The article aims to demonstrate the challenges of differential diagnosis of UC and CD in a child with rectal stenosis. In the described case, low compliance in a girl with UC led to significant errors in traditional therapy regimens, the development of complications that irreversibly change the anatomical structure of the colon and complicate the examination, mimicking the course of stenosing CD. The clinical case emphasizes the need for more detailed criteria for differential diagnosis and additional therapeutic algorithms, with an earlier use of genetically engineered biological agents as disease-modifying therapy.

Keywords: inflammatory bowel disease, ulcerative colitis, Crohn's disease, differential diagnosis, rectal stenosis

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1. Lomazi EA, Oba J, Rodrigues M, et al. Brazilian consensus on the management of inflammatory bowel diseases in pediatric patients: a consensus of the Brazilian organization for Crohn's disease and colitis (GEDIIB). Arq Gastroenterol. 2023;59 (suppl. 1):85-124. DOI:10.1590/S0004-2803.2022005S1-04
2. Kornienko EA. Vospalitel'nye zabolevaniia kishechnika u detei. Moscow: Prima Print, 2019 (in Russian).
3. Vernon-Roberts A, Chan P, Christensen B, et al. Pediatric to Adult Transition in Inflammatory Bowel Disease: Consensus Guidelines for Australia and New Zealand. Inflammatory Bowel Diseases. 2024;izae087. DOI:10.1093/ibd/izae087
4. Kuenzig ME, Fung SG, Marderfel L, et al. Тwenty-first century trends in the global epidemiology of pediatric-onset inflammatory bowel disease: systematic review. Gastroenterology. 2022;162(4):1147-59. e4.
5. Ulcerative Colitis. Clinical Guidelines. Available at: https://cr.minzdrav.gov.ru/preview-cr/391_3. Accessed: 16.10.2024 (in Russian).
6. Crohn's disease. Clinical guidelines. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/682_2. Accessed: 16.10.2024 (in Russian).
7. Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care – An Evidence-based Guideline From European Crohn’s and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018;67(2):257-91. DOI:10.1097/MPG.0000000000002035
8. Chu X, Biao Y, Liu C, et al. Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis. BMC Gastroenterol. 2023;23(1):346. DOI:10.1186/s12876-023-02938-6
9. Garber A, Regueiro M. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, etiopathogenesis, and management. Curr Gastroenterol Rep. 2019;21(7):31. DOI:10.1007/s11894-019-0698-1
10. Rogler G, Singh A, Kavanaugh A, Rubin DT. Extraintestinal manifestations of inflammatory bowel disease: current concepts, treatment, and implications for disdisease management. Gastroenterology. 2021;1614:1118-32. DOI:10.1053/j.gastro.2021.07.042
11. van Rheenen PF, Aloi M, Assa A, et al. The Medical Management of Paediatric Crohn’s Disease: an ECCO-ESPGHAN Guideline Update. J Crohns Colitis. 2021;15(2):171-94. DOI:10.1093/ecco-jcc/jjaa161
12. Birimberg-Schwartz L, Wilson DC, Kolho KL, et al.; paediatric IBD Porto group of ESPGHAN. pANCA and ASCA in Children with IBD-Unclassified, Crohn's Colitis, and Ulcerative Colitis-A Longitudinal Report from the IBD Porto Group of ESPGHAN. Inflamm Bowel Dis. 2016;22(8):1908-14. DOI:10.1097/MIB.0000000000000784
13. Levine A, Koletzko S, Turner D, et al. ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014;58(6):795-806. DOI:10.1097/MPG.0000000000000239
14. Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care-An Evidence-based Guideline From European Crohn's and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition: Erratum. J Pediatr Gastroenterol Nutr. 2020;71(6):794. DOI:10.1097/MPG.0000000000002967. Erratum for: J Pediatr Gastroenterol Nutr. 2018;67(2):257-91. DOI:10.1097/MPG.0000000000002035
15. Carvalho RS, Abadom V, Dilworth HP, et al. Indeterminate colitis: a significant subgroup of pediatric IBD. Inflamm Bowel Dis. 2006;12(4):258-62. DOI:10.1097/01.MIB.0000215093.62245.b9
16. Heyman MB, Kirschner BS, Gold BD, et al. Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr. 2005;146(1):35-40. DOI:10.1016/j.jpeds.2004.08.043
17. Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol. 1989;24(suppl. 170):2-6.
18. Winter DA, Karolewska-Bochenek K, Lazowska-Przeorek I, et al. Pediatric IBD-unclassified is less common than previously reported; results of an 8-year audit of the EUROKIDS registry. Inflamm Bowel Dis. 2015;21:2145-53.
19. Birimberg-Schwartz L, Zucker DM, Akriv A, et al. Development and validation of diagnostic criteria for IBD subtypes including IBD-unclassified in children: a multicentre study from the pediatric IBD Porto Group of ESPGHAN. J Crohns Colitis. 2017;11:1078-84.
20. Amil-Dias J, Kolacek S, Turner D, et al. Surgical Management of Crohn Disease in Children: Guidelines From the Paediatric IBD Porto Group of ESPGHAN. JPGN. 2017;64(5):818-35. DOI:10.1097/MPG.0000000000001562
21. Sosna B, Aebisher D, Myśliwiec A, et al. Selected Cytokines and Metalloproteinases in Inflammatory Bowel Disease. Int J Mol Sci. 2024;25:202. DOI:10.3390/ijms25010202
22. Blackburn SC, Wiskin AE, Barnes C, et al. Surgery for children with Crohn’s disease: indications, complications and outcome. Arch Dis Child. 2014;99:420-26. DOI:10.1136/archdischild-2013-305214
23. Fedulova EN, Shabunina EI, Gordetsov AS, Lebedev AV. A new approach to the differential diagnosis Crohn’s disease and ulcerative colitis in children. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta im. I.I. Mechnikova. 2013;5(1):84-7 (in Russian).
24. IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis – the Porto criteria. J Pediatr Gastroenterol Nutr. 2005;41(1):1-7. DOI:10.1097/01.mpg.0000163736.30261.82
25. Horn MP, Peter AM, Righini Grunder F, et al. PR3-ANCA and panel diagnostics in pediatric inflammatory bowel disease to distinguish ulcerative colitis from Crohn’s disease. PLoS ONE. 2018;13(12):e0208974. DOI:10.1371/journal.pone.0208974.
26. Kang DY, Park JL, Yeo MK, et al. Diagnosis of Crohn’s disease and ulcerative colitis using the microbiome. BMC Microbiol. 2023;23(1):336. DOI:10.1186/s12866-023-03084-5
27. Kasperczuk A, Daniluk J, Dardzinska A. Smart Model to Distinguish Crohn’s Disease from Ulcerative Colitis. Appl Sci. 2019;9(8):1650. DOI:10.3390/app9081650
28. Maurício J, Domingues I. Distinguishing between Crohn’s disease and ulcerative colitis using deep learning models with interpretability. Pattern Anal Applic. 2024;27(1). DOI:10.1007/s10044-023-01206-3

Авторы

А.М. Римская*¹, И.С. Самолыго¹, Ю.К. Лим¹, Е.А. Яблокова^1,2, А.В. Горелов^1,3

¹ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
²ГБУЗ МО «Научно-исследовательский клинический институт детства» Минздрава Московской области, Москва, Россия;
³ФБУН «Центральный научно-исследовательский институт эпидемиологии» Роспотребнадзора, Москва, Россия
*drrimskaya@yandex.ru

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Alena M. Rimskaya*¹, Ivan S. Samolygo¹, Yuen Kai Lim¹, Ekaterina A. Yablokova^1,2, Aleksandr V. Gorelov^1,3

¹Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
²Clinical Institute of Childhood, Moscow, Russia;
³Central Research Institute of Epidemiology, Moscow, Russia
*drrimskaya@yandex.ru

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