title: Digestive perianastomotic ulcerations and Crohn's disease.
abstract: OBJECTIVE
  Digestive perianastomotic ulcerations (DPAU) have been occasionally reported as late complications of neonatal or childhood surgery.
  
  
  METHODS
  We report here a series of 14 new cases.
  
  
  RESULTS
  Cases were revealed by severe anemia, diarrhea, abdominal pain and growth failure in average 11.5 years after surgery. Ulcerations were most often multiple (n=11), located on the upper part of ileocolonic anastomoses (n=12) and difficult to treat. No granulomas were seen but lymphoid follicles were frequent. In addition, either ASCA or ANCA were positive in 4/9 tested patients and 8/11 genotyped patients exhibited a NOD2 mutation (P<0.0002 when compared to French healthy controls).
  
  
  CONCLUSIONS
  Altogether, these findings argue for common physiopathological features between DPAU and Crohn's disease and for a prospective follow-up of selected operated children to explore the early events involved in gut inflammatory lesions.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Services des Maladies Digestives et Respiratoires de l'enfant, Service de Chirurgie Digestive et Service de Cytologie et Pathologie, Hôpital Robert Debré, 75019 Paris, France.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Frémond
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Services des Maladies Digestives et Respiratoires de l'enfant, Service de Chirurgie Digestive et Service de Cytologie et Pathologie, Hôpital Robert Debré, 75019 Paris, France; Université Paris-Diderot UMR 1149, Labex Inflamex, 75018 Paris, France; INSERM UMR1149, Centre de Recherche sur l'inflammation Paris Montmartre, 75018 Paris, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Viala
authors.affiliation: Université Paris-Diderot UMR 1149, Labex Inflamex, 75018 Paris, France; INSERM UMR1149, Centre de Recherche sur l'inflammation Paris Montmartre, 75018 Paris, France; Assistance Publique-Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Beaujon, 92000 Clichy, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Tréton
authors.affiliation: Université Paris-Diderot UMR 1149, Labex Inflamex, 75018 Paris, France; INSERM UMR1149, Centre de Recherche sur l'inflammation Paris Montmartre, 75018 Paris, France.
authors.forename: Maryline
authors.initials: M
authors.lastname: Roy
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Services des Maladies Digestives et Respiratoires de l'enfant, Service de Chirurgie Digestive et Service de Cytologie et Pathologie, Hôpital Robert Debré, 75019 Paris, France; Université Paris-Diderot UMR 1149, Labex Inflamex, 75018 Paris, France; INSERM UMR1149, Centre de Recherche sur l'inflammation Paris Montmartre, 75018 Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Berrebi
authors.affiliation: Inserm U995, Hôpital Jeanne de Flandre, 59000 Lille, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gottrand
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Services des Maladies Digestives et Respiratoires de l'enfant, Service de Chirurgie Digestive et Service de Cytologie et Pathologie, Hôpital Robert Debré, 75019 Paris, France; Université Paris-Diderot UMR 1149, Labex Inflamex, 75018 Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Services des Maladies Digestives et Respiratoires de l'enfant, Service de Chirurgie Digestive et Service de Cytologie et Pathologie, Hôpital Robert Debré, 75019 Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Martinez-Vinson
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Services des Maladies Digestives et Respiratoires de l'enfant, Service de Chirurgie Digestive et Service de Cytologie et Pathologie, Hôpital Robert Debré, 75019 Paris, France; Université Paris-Diderot UMR 1149, Labex Inflamex, 75018 Paris, France; INSERM UMR1149, Centre de Recherche sur l'inflammation Paris Montmartre, 75018 Paris, France. Electronic address: jean-pierre.hugot@rdb.aphp.fr.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Hugot
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002648:Child; D003424:Crohn Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D020345:Enterocolitis, Necrotizing / Q000601:surgery; D005260:Female; D020139:Gastroschisis / Q000601:surgery; D006579:Heterozygote; D006627:Hirschsprung Disease / Q000601:surgery; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology*; D008297:Male; D009154:Mutation; D053473:Nod2 Signaling Adaptor Protein / Q000235:genetics; D011183:Postoperative Complications / Q000175:diagnosis*; D013997:Time Factors; D014456:Ulcer / Q000209:etiology*; D055815:Young Adult
chemical_list: C429018:NOD2 protein, human; D053473:Nod2 Signaling Adaptor Protein
keywords: Crohn's disease; Digestive perianastomotic ulcerations; Ileocolonic anastomosis; Nod2; Small bowel surgery; Ulcers