اولین شعله‌وری بیماری کرون پس از ترومای مقعدی در یک پسربچه 5/2 ساله: گزارش یک مورد

زمینه و هدف: بیماری کرون یک اختلال ناهمگن با اتیولوژی‌های چندعاملی به حساب می‌آید که در آن تعامل ژنتیک و محیط باعث ظهور بیماری می‌گردد. تجربیات نامطلوب کودکی می‌تواند پیامدهای سلامت جسمی و روانی آینده را تحت تاثیر قرار دهد. عصب‌دهی غنی روده با عصب واگ و تعاملات هورمونی از یک سو و برخورد دائمی دستگاه گوارش با انواع آنتی‌ژن هم نقش ثابت شده‌ای در این بیماری دارد.معرفی بیمار: در این مقاله به گزارش یک مورد ترومای through & through مقعدی در یک کودک 5/2 ساله در بیمارستان اکبر مشهد در بهار 1402 می‌پردازیم که تیم درمانی در حین کولونوسکوپی کنترلی برای بستن کولوستومی اولیه متوجه بیماری کرون در وی می‌شوند.نتیجه‌گیری: تروما می‌تواند یک عامل برهم زننده‌ی ایمنی در دستگاه گوارش شده و از طرف دیگر تلاش برای تنظیم مجدد محور روده‌ای مغزی می‌تواند به‌عنوان یک هدف درمانی برگزیده شود.

initial crohn’s disease flare-up following an anal trauma in a 2.5-year-old boy: a case report

background: crohn’s disease is considered a heterogeneous disorder with multi-factorial etiologies, in which the interaction of genetics and environment manifests the disease. adverse childhood experiences can affect future physical and mental health outcomes. the rich innervation of the intestine with the vagus nerve and hormonal interactions on the one hand and the constant contact of the digestive system with various pathogenic and non-pathogenic antigens have a proven role in autoimmune diseases and can gradually be chosen as a therapeutic goal.case presentation: we are reporting a case of crohn’s flare-up after trauma in a pediatric case. a 2.5-year-old male with a through and through anal trauma was presented in akbar children’s hospital, mashhad, iran, spring 2023 with active bleeding but conscious. he then underwent a physical examination under general anesthesia in the operating room. at the lithotomy position, a penetrating wound at the 3 o’clock anal verge and a tear in the perineal area at 9 o’clock, which, according to the evidence of pus discharge, were seen hours after the incident which was irrigated with normal saline and hydrogen peroxide respectively. due to the contamination of the area, a supportive colostomy was decided to be closed after six months. at the appointed time during the colonoscopy, the pediatric gastroenterologist noticed extensive inflammation in the distal patch of the colon, which was consistent with crohn’s disease. histopathological studies then confirmed this diagnosis. this was even though there were no symptoms of inflammatory bowel disease in the history of the boy’s illness before the accident. the patient is then treated with prednisolone, asacol, and ciprofloxacin, and after the disease subsides, the colostomy surgery team closes the disease.conclusion: trauma can be an immune-disrupting factor in the digestive system, and trying to reset the brain-gut axis can be chosen as a therapeutic goal.