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Images in paediatrics
Crohn’s disease presenting as bladder mass A previously well 15-year-old boy presented with a month-long history of bloody diarrhoea, weight loss, low albumin and coexistent dysuria. An ultrasound of the abdomen showed appearances suggestive of terminal ileal thickening and mesenteric oedema. There was also an irregular bladder wall mass measuring 1.5 cm in maximal thickness (figure 1). An MRI showed appearances consistent with Crohn’s disease, with marked inflammatory change in the distal small bowel and proximal small bowel dilatation to 4.3 cm. The apparent thickening of the bladder wall was adjacent to the area of inflamed bowel and considered most likely to be a reaction secondary to this. His bladder and bowel symptoms rapidly improved with mesalazine alone, and so he was not referred to further urological investigation. Follow-up ultrasound 5 months later demonstrated resolution of the bladder mass (figure 2). This is the first report of a child with this novel presentation of Crohn’s disease. Previous reports linking bladder masses to Crohn’s disease occurred in patients with established disease and previous surgery.1 2 Adult case reports suggest that Crohn’s disease is a risk factor for genitourinary malignancies.1 2 In addition, the synchronous improvement in intestinal Crohn’s disease and resolution of the bladder mass could point to mesa-
Figure 2 Ultrasound scan transverse view of the bladder 5 months later showing a smooth posterior bladder wall and resolution of the irregular mass.
lazine effecting clinical response beyond acting locally on the colonic mucosa, or that reducing intestinal disease is key to improving bladder involvement.3 Claire Elizabeth Evans, Mark Peter Tighe Department of Paediatrics, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK Correspondence to Dr Claire Elizabeth Evans, Department of Paediatrics, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset, BH15 2JB, UK; claire. [email protected] Contributors CEE involved in acquisition of data from patient’s notes and from previous published articles, drafted the work and revised it as appropriate, approved the final version for publication and agreed to be accountable for all aspects of the work; MT came up with the concept for the publication and assisted in the acquisition and analysis of data, critically revised the report, approved the final version for publication. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed. To cite Evans CE, Tighe MP. Arch Dis Child 2014;99:256. Accepted 22 November 2013 Published Online First 13 December 2013 Arch Dis Child 2014;99:256. doi:10.1136/archdischild-2013-305500
REFERENCES 1 2
Figure 1 Ultrasound scan transverse view of the bladder on initial presentation showing marked irregular posterior bladder wall mass.
256
3
Bales GT, Straus FH, Gerber GS. Crohn’s disease and urinary bladder mass. Diagn Ther Endosc 1995;1:233–6. Evans RH. Crohn’s disease mimicking primary bladder tumour. Br J Urol 1990;65:299–300. Lacucci M, De Silva S, Ghosh S. Mesalazine in inflammatory bowel disease: a trendy topic once again? Can J Gastroenterol 2010;24:127–33.
Evans CE, et al. Arch Dis Child March 2014 Vol 99 No 3
Downloaded from http://adc.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Crohn's disease presenting as bladder mass Claire Elizabeth Evans and Mark Peter Tighe Arch Dis Child 2014 99: 256 originally published online December 13, 2013
doi: 10.1136/archdischild-2013-305500 Updated information and services can be found at: http://adc.bmj.com/content/99/3/256
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This article cites 3 articles, 0 of which you can access for free at: http://adc.bmj.com/content/99/3/256#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Crohn's disease (39) Clinical diagnostic tests (1096) Radiology (945) Radiology (diagnostics) (744) Competing interests (ethics) (173) Diarrhoea (179) Journalology (226) Small intestine (46) Child health (3817)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Images in paediatrics
Crohn’s disease presenting as bladder mass A previously well 15-year-old boy presented with a month-long history of bloody diarrhoea, weight loss, low albumin and coexistent dysuria. An ultrasound of the abdomen showed appearances suggestive of terminal ileal thickening and mesenteric oedema. There was also an irregular bladder wall mass measuring 1.5 cm in maximal thickness (figure 1). An MRI showed appearances consistent with Crohn’s disease, with marked inflammatory change in the distal small bowel and proximal small bowel dilatation to 4.3 cm. The apparent thickening of the bladder wall was adjacent to the area of inflamed bowel and considered most likely to be a reaction secondary to this. His bladder and bowel symptoms rapidly improved with mesalazine alone, and so he was not referred to further urological investigation. Follow-up ultrasound 5 months later demonstrated resolution of the bladder mass (figure 2). This is the first report of a child with this novel presentation of Crohn’s disease. Previous reports linking bladder masses to Crohn’s disease occurred in patients with established disease and previous surgery.1 2 Adult case reports suggest that Crohn’s disease is a risk factor for genitourinary malignancies.1 2 In addition, the synchronous improvement in intestinal Crohn’s disease and resolution of the bladder mass could point to mesa-
Figure 2 Ultrasound scan transverse view of the bladder 5 months later showing a smooth posterior bladder wall and resolution of the irregular mass.
lazine effecting clinical response beyond acting locally on the colonic mucosa, or that reducing intestinal disease is key to improving bladder involvement.3 Claire Elizabeth Evans, Mark Peter Tighe Department of Paediatrics, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK Correspondence to Dr Claire Elizabeth Evans, Department of Paediatrics, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset, BH15 2JB, UK; claire. [email protected] Contributors CEE involved in acquisition of data from patient’s notes and from previous published articles, drafted the work and revised it as appropriate, approved the final version for publication and agreed to be accountable for all aspects of the work; MT came up with the concept for the publication and assisted in the acquisition and analysis of data, critically revised the report, approved the final version for publication. Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed. To cite Evans CE, Tighe MP. Arch Dis Child 2014;99:256. Accepted 22 November 2013 Published Online First 13 December 2013 Arch Dis Child 2014;99:256. doi:10.1136/archdischild-2013-305500
REFERENCES 1 2
Figure 1 Ultrasound scan transverse view of the bladder on initial presentation showing marked irregular posterior bladder wall mass.
256
3
Bales GT, Straus FH, Gerber GS. Crohn’s disease and urinary bladder mass. Diagn Ther Endosc 1995;1:233–6. Evans RH. Crohn’s disease mimicking primary bladder tumour. Br J Urol 1990;65:299–300. Lacucci M, De Silva S, Ghosh S. Mesalazine in inflammatory bowel disease: a trendy topic once again? Can J Gastroenterol 2010;24:127–33.
Evans CE, et al. Arch Dis Child March 2014 Vol 99 No 3
Downloaded from http://adc.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Crohn's disease presenting as bladder mass Claire Elizabeth Evans and Mark Peter Tighe Arch Dis Child 2014 99: 256 originally published online December 13, 2013
doi: 10.1136/archdischild-2013-305500 Updated information and services can be found at: http://adc.bmj.com/content/99/3/256
These include:
References Email alerting service
Topic Collections
This article cites 3 articles, 0 of which you can access for free at: http://adc.bmj.com/content/99/3/256#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Crohn's disease (39) Clinical diagnostic tests (1096) Radiology (945) Radiology (diagnostics) (744) Competing interests (ethics) (173) Diarrhoea (179) Journalology (226) Small intestine (46) Child health (3817)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
