The roentgenologic aspects of chronic ulcerative colitis in children.

Abstract

This is a review of 122 cases of ulcerative colitis in children seen at the Mayo Clinic between January 1944 and January 1954. Numerous articles have appeared describing the disease in adults (1–4), and in 1940 Jackman, Bargen, and Helmholz (5) reported 95 cases in children. These latter writers stated that ulcerative colitis is apt to be more severe among children than among adults, with a poorer response to treatment and more complications. When the disease occurs in childhood, general growth and development are often diminished. The present paper concerns particularly the roentgen aspects of the condition. In each case some combination of clinical, roentgenologic, and proctoscopic evidence of idiopathic chronic ulcerative colitis was present. Amebiasis and tuberculous ulcerative colitis have been excluded from this study. Chronic ulcerative colitis occurs almost twice as often among boys as among girls; 76 of the 122 children whose cases we reviewed were boys. The cases were divided rather arbitrarily into the following groups, based on the age of the patient: birth to four years, 11 cases; five to nine years, 28 cases; ten through fifteen years, 83 cases. The disease occurs with increasing frequency up to fifteen years of age. Early adolescence appears to be a particularly dangerous time because of rapid progression of the disease and severe changes in short periods. We have not seen chronic ulcerative colitis in a child less than eighteen months of age. Dr. John W. Hope (6) of Philadelphia, however, has observed a case in an infant of six weeks, the youngest patient of whom we have heard with this disease. Clinical Aspects The onset of chronic ulcerative colitis in childhood may be gradual and insidious or it may be sudden. Its type has a bearing on the roentgenologic findings, since, if there is a rather sharp onset of bloody diarrhea, extensive roentgen changes may be apparent within less than two weeks. Bloody diarrhea is characteristic of the disease and, with few exceptions, is present in every case. Frequently the onset is related to some inflammatory episode involving the respiratory tract. Of equal value with the roentgenologic study is the proctosigmoidoscopic examination. The correlation between the proctoscopic findings and the roentgenologic manifestations of early disease is very good. Rarely (3 cases) will the roentgenologic findings be negative if the proctoscope shows evidence of ulcerative colitis. Similarly, positive roentgenographic evidence of disease is uncommon (6 cases) in the face of negative proctoscopic findings. Apparently no time lag exists between the proctoscopic diagnosis of chronic ulcerative colitis and the roentgenologic diagnosis. A careful review of the cases reported here reveals no significant difference in the diagnostic results of these procedures; it serves only to emphasize the necessity of both examinations.