Open Access Case Report

A Girl with Crohn’s Disease in a Tertiary Care Hospital of Togo: A Case Report

Aklesso Bagny, Djatougbe Ayaovi Elie Akolly, Lidawu Roland Moise Kogoe, Koffi Edem Djadou

Asian Journal of Research and Reports in Gastroenterology, Page 28-31

Background: Along with ulcerative colitis, Crohn’s disease is one of a group disease known as inflammatory bowel disease. Crohn’s disease is a rare in pediatric population. It most common through people who are between the ages fifteen and thirty. Manifestation in pediatric are more severe than adult and need long term management.

Case Report: We report a case of Crohn’s disease in a 14 years old girl who presented with passage of loose bloody stool, low grade intermittent fever, abdominal pain with tenesmus and arthralgia of large joint along with significant wt loss. Diagnosis was confirmed by colonoscopy and biopsy. Treatment was thereafter started with salazopyrine. The patient is now on remission and is on regular follow up.

Conclusion: Crohn’s disease in children with appropriate diagnosis and therapy has good prognosis.

Open Access Case Study

Calcium Polystyrene Sulfonate Induced Necrotizing Ulcerative Enterocolitis - Not Just an Innocent Bystander

Keng Hoong Chiam, Angeline Madatang, Wong Zhe Yun Daphnie, Raman Muthukaruppan

Asian Journal of Research and Reports in Gastroenterology, Page 10-15

Introduction and Aims: Resins are non-absorbable medications that facilitates ion exchange and are commonly used in the treatment of hyperkalemia. Crystal deposition by these resins could result in and aggravate colonic mucosal damage. This rare but serious adverse event is under-recognized and is reportedly associated with life-threatening enterocolitis. We would like to present a case of necrotizing ulcerative enterocolitis in a patient with acute dysentery with concomitant calcium polystyrene sulfonate (CPS) prescription.

Case Presentation: An 85-year-old lady presented to us with generalized abdominal pain and bloody diarrhea for one week. She was febrile, dehydrated and lethargic. Her abdomen was soft with non-specific generalized mild tenderness. Other clinical examination was unremarkable. Laboratory indices revealed raised inflammatory markers with acute on chronic kidney disease (CKD). Relevant findings include hyperkalemia, metabolic acidosis and tall-tented T waves on her electrocardiographic (ECG) recordings. A working diagnosis of acute dysentery complicated by acute on CKD was made and urgent resuscitative measures begun. While waiting for hemodialysis, she was started on antibiotics, intravenous fluids, oral CPS powder and a cocktail regime of 10% calcium gluconate, insulin and 50% dextrose for hyperkalemia reversal and cardioprotective measures. Despite this, her symptoms worsened with massive bouts of hematochezia requiring blood transfusion three days later. An urgent ileocolonoscopy revealed extensive pancolonic with ileal ulceration. The possibility of ischemic colitis on top of the infectious colitis was considered. Biopsies taken was consistent with CPS-induced necrotizing ulcerative enterocolitis. Her cultures and infective workup were negative. Despite our efforts, she succumbed a week later from multiple contributing issues.

Discussion and Conclusion: This case highlights the negative prospect of prescribing CPS to patients with any forms of colitis as it could further worsen the underlying pathology. One needs to be mindful of the adverse event and consider a higher threshold for prescribing it in certain cases.

Open Access Case Study

Recurrent Abdominal Pain of Unusual Cause: An Elaborative History is always Rewarding!

Sharad Dev, Dawesh Prakash Yadav, Sunit Kumar Shukla, Vinod Kumar Dixit

Asian Journal of Research and Reports in Gastroenterology, Page 16-19

Lead poisoning has been recognized as a major public health risk. We present a case of middle aged female, who presented with recurrent episodes of severe abdominal pain , which remains obscure even after thorough clinical evaluation and extensive investigations. Lastly, blood lead levels were ordered which came out to be significantly raised and diagnosis of lead intoxication was made convincingly. On reviewing the case, history of intake of herbal medication containing lead based ingredient justified the diagnosis. Therefore, even though the diagnosis represents a challenge, a physician must always include this possibility in the differential diagnosis for cases with suggestive symptoms.

Open Access Original Research Article

Prevalence and Predictors of Rotavirus Infection among Children Aged 0-5 Years with Gastroenteritis in 2 Selected Healthcare Centres in Keffi, Nigeria

I. Ibrahim, R. U. Usman, H. I. Mohammed, D. Ishaleku

Asian Journal of Research and Reports in Gastroenterology, Page 1-9

Aims: This study was conducted to evaluate the prevalence and predictors of Rotavirus infection among children aged 0-5 years with gastroenteritis in 2 selected healthcare centres in Keffi, Nigeria.

Study Design: The study was a cross sectional study.

Place and Duration of Study: Keffi, Nasarawa State, between March and June 2019.

Methodology: 303 stool samples (203 from FMC Keffi and 100 from PHC Angwan Waje, Keffi) were collected from children with gastroenteritis and information about them were obtained by structured questionnaires. All collected samples were screened for the presence of Rotavirus antigen using Aria Rotavirus antigen detection test kit (CTK Biotech, Inc, San Diego, USA).  Data collected were analysed using Smith’s Statistical Package (version 2.8, California, USA) and P value of ≤ 0.05 was considered statistically significant.

Results: A total of 303 children with gastroenteritis majority of who were males (157/303) aged 0-12 months (153/303) were screened. Of them, 54(17.8%) tested positive for Rotavirus infection of which 41(20.2%) were from FMC Keffi while the remaining 13(13.0%) were from PHC Angwan Waje, Keffi. Highest prevalence of the viral infection was recorded among males (19.7%) of 0-12 months of age (24.8%). Gender, source of water, exclusive breastfeeding, vomiting and diarrhea episodes (per day) were predictors of Rotavirus infection in this study (P<0.05). However, age, day care attendance and stool appearance were not significantly associated with the viral infection (P>0.05).

Conclusion: This study reveals the presence of Rotavirus infection in the study population. Therefore, there is need to include Rotavirus infection in the differential diagnosis of infantile gastroenterites to avoid misdiagnosis and mistreatment. There is also the need to include Rotavirus vaccine in the Expanded Program on Immunization (EPI) in Nigeria so as to protect children aged 0-5 years from rotavirus induced diarrhea.

Open Access Original Research Article

Early and Long-Term Outcome of Rubber Band Ligation for Haemorrhoidal Disease

Emeka Ray-Offor, Kalanne Ada Opusunju

Asian Journal of Research and Reports in Gastroenterology, Page 20-27

Background: Rubber band ligation is widely practiced for treatment of haemorrhoidal disease.

Aims: To study the early and long-term outcome of rubber band ligation for grades I-III haemorrhoids.

Study Design: A prospective cohort study.

Place and Duration of Study: Oak Endoscopy Centre (Digestive Disease Unit) Port Harcourt, Rivers State Nigeria between June 2017, and October 2020.l

Methodology: We included one hundred and thirteen cases of rubber band ligations in 41 patients (32 males and 9 female; 24-75 years), with haemorrhoids of varying grades. The variables studied were sociodemographic, presenting complaints, anti-platelet/ anti-clotting drug history, sites of haemorrhoids, sessions of haemorrhoidal rubber band ligation, early and long-term outcome. Statistical analysis was done using IBM SPSS version 20.

Results: The mean age of study patients was  51.3 ± 13.0 years and there were 9(22.0%) patients with grade I haemorrhoids, 17 (41.4%) grade II, and 15 (36.6%) gade III. The most common site was 7 clock-dial position- 29(25.7%). There was complete resolution of symptoms in 90.2%, 81.8% and 80.8% of patients after 1-month, 6-month, and 1-year follow-up, respectively. No significant difference in resolution rate of haemorrhoids following rubber band ligation was observed with respect to the grades (P = 0.769).

Conclusion: Rubber band ligation is effective for the treatment of grades I-III haemorrhoids with a low but significant recurrence rate in study population at 1-year follow-up.