title: Etiologic and clinical analysis of chronic complex anal and rectal inflammation in children less than 3 years old.
abstract: OBJECTIVE
  To analyze the etiology and clinical diagnostic method for chronic complex anal and rectal inflammation in children less than 3 years old.
  
  
  METHODS
  Seven children (5 males and 2 females; 1 year 8 months to 3 years of age at the time of physician evaluation) with chronic complex anal and rectal inflammation were enrolled between May 2008 and May 2013 at our hospital. Clinical history, results of auxiliary examinations, and empirical treatment of the children were analyzed retrospectively combined with the etiologic diagnosis.
  
  
  RESULTS
  Four patients were confirmed to have Crohn's disease and one patient was confirmed to have intestinal tuberculosis; two patients were suspected to have Crohn's disease. Anemia and low pre-albumin level were common (seven patients); serologic testing revealed four patients with elevated IgG levels and seven patients with elevated IgA levels; there were no patients with positive tuberculosis antibody titers and two patients were weakly positive for C-ANCA (one patient with Crohn's disease and one patient intestinal tuberculosis). Colonoscopies revealed that the entire colon was affected in one patient, the left hemicolon was affected in four patients, and the sigmoid colon and rectum were affected in two patients. Two patients with Crohn's disease and one patient with intestinal tuberculosis were diagnosed by colonoscopies in combination with histopathologic examinations. Two patients with Crohn's disease were confirmed after empirical drug treatment, and two other patients were not definitely diagnosed.
  
  
  CONCLUSIONS
  The possibility of Crohn's disease or intestinal tuberculosis should be considered in the clinical diagnosis of complex chronic anal and rectal inflammation in younger children. Local surgery is sometimes unnecessary. Empirical drug treatment should be used if necessary.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Fudan University Shanghai 201102, P.R. China.
authors.forename: Yanlei
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Fudan University Shanghai 201102, P.R. China.
authors.forename: Shan
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Fudan University Shanghai 201102, P.R. China.
authors.forename: Xianmin
authors.initials: X
authors.lastname: Xiao
keywords: Anal infection; anal stenosis; multiple fistulas; rectal infection; younger children