Cristina Oana Mărginean, Lorena Elena Melit, Maria Oana Marginean, Nicoleta Suciu, Raluca Damian and Simona Mocan

ABSTRACT

Pancreatic metaplasia is defined as the development of pancreatic tissue in an abnormal location and without direct connection to the pancreas. The heterotopic pancreatic tissue is most frequently noticed in the antral gastric mucosa, duodenum and jejunum. We present the case of a 13-year-old patient, admitted in Pediatrics Clinic 1 Targu-Mures, for recurrent abdominal pain and heartburns. The laboratory tests pointed out lymphocytosis (41%) with monocytosis (8.9%), eosinophilia (4.9%), an increased number of reticulocytes (20%), a decreased serum level of triglycerides and a value above the superior limit for calcium and magnesium. The abdominal ultrasound did not reveal any pathological modifications. The superior digestive endoscopy showed a granular gastric mucosa, therefore we took a biopsy of the antral mucosa, The pathological exam pointed out a fragment of pancreatic metaplasia in the antral gastric mucosa. The evolution was favorable with diet and treatment for the associated lesions. The particularity of the case consists in the presence of pancreatic metaplasia of the gastric mucosa in a patient with recurrent abdominal pain and heartburns, without significant familial or personal history.

Keywords: pancreatic metaplasia, child, abdominal pain, heartburn

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Lorena Elena Melit, Cristina Oana Mărginean, Raluca Damian, Maria Oana Marginean and Andreea Dinca

ABSTRACT

Ulcer disease is a pathology with low incidence in pediatric population, with an unspecific symptomatology or even absent, thus leading to the development of complications. We present the case of 2 years and 10 monthold male patient, admitted in the regional hospital with the diagnosis of febrile acute gastroenteritis, who in evolution (after 5 days) associated digestive hemorrhage, thus being transferred in the Pediatrics Clinic I, Targu-Mures. The superior digestive endoscopy performed after the hemodynamic and metabolic re-equilibration, pointed out 2 ulcers in the duodenal mucosa, one with active bleeding. The treatment with proton pump inhibitors and the adequate diet initiated determined the patient’s favorable evolution. The particularity of the case consists in the appearance of 2 duodenal ulcers of the duodenal mucosa in a small child, without significant personal history, with adequate life conditions, without associated risk factors and without infection with Helicobacter pylori.

Keywords: “kissing-ulcer”, child, superior digestive hemorrhage

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Andreea Dinca, Cristina Oana Mărginean, Lorena Elena Melit, Maria Oana Marginean and Raluca Damian

ABSTRACT

Acute gastroenteritis with Clostridium difficile is insufficiently studied in the specialty literature due to its small incidence at this age, with increased rates of morbidity and mortality. We present the case of a 1 year and 10 month-old child, diagnosed with hereditary lactose intolerance in the neonatal period, admitted in the Pediatrics Clinic I, Targu-Mures, for vomiting, loss of appetite, decreased consistency stools, with a bed smell, with bacterial infection signs in the blood tests and slowly favorable evolution under treatment with cephalosporin. The patient is readmitted after 1 day from discharge with the reappearance of bad smell stools and loss of appetite, with unfavorable evolution after administering a 3rd generation cephalosporin, thus we raise the suspicion of infection with Clostridium difficile, confirmed by the identification of toxins in the stools, with favorable evolution under treatment for anaerobe germs (metronidazole). The particularity of the case consists in the development of a gastroenteritis with Clostridium difficile in a small child (1 year and 10 months), known with retardation in the neuro-psychomotor and language development, repeated episodes of hypoglycemia, with hereditary lactose intolerance which represented a challenge in establishing the diagnosis.

Keywords: Clostridium difficile, child, gastroenteritis, hereditary lactose intolerance

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Lorena Elena Melit, Oana Cristina Marginean, Mihaela Chincesan, Andreea Dinca, Raluca Damian and Maria Oana Marginean

ABSTRACT

Burkitt lymphoma, a subtype of non-Hodgkin lymphomas, appears especially in small ages and it presents the most rapid tumor growth encountered in the human beings. We present the case of a 5 year-old child who presents diffuse, abdominal pain, abdominal distension and decreased consistency stools, and who is transferred in the Pediatrics Clinic 1 Targu-Mures, with the diagnosis of severe malnutrition and hypoproteinemia edema of unknown etiology. The laboratory investigations performed showed leukocytosis, mildly increased erythrocyte sedimentation rate, anemia, decreased level of serum proteins, and also an increased level of LDH. The abdominal ultrasound revealed intraperitoneal fluid, and the abdominal CT exam showed free fluid between the intestinal loops, 2 fistulas, one between the duodenum and the colon, and the other one between the jejunum and the colon, but also enlarged lymph nodes. The surprise during the surgery is the discovery of a tumor mass which involves the duodenum, the jejunum and the colon, and the pathological exam establishes the diagnosis of Burkitt lymphoma, extranodal type, with evolution after surgery burdened by multiple complications. After the third surgical intervention, the chemotherapy is initiated. Even though in some cases, the clinical picture is not suggestive for the severity of the pathology, the clinician’s perseverance is the one that finally leads to the establishment of the diagnosis.

Keywords: Burkitt lymphoma, child, diagnosis.

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