Endgames Case Report

Inflammatory bowel disease: a classic case of Dalziel’s disease

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4932 (Published 13 October 2010) Cite this as: BMJ 2010;341:c4932
  1. Fiona Louise Cameron, specialty registrar in paediatrics1,
  2. Richard Hansen, clinical lecturer in child health2,
  3. David Goudie, consultant in paediatrics1
  1. 1Raigmore Hospital, Inverness, UK
  2. 2University of Aberdeen, Royal Aberdeen Children’s Hospital, Foresterhill, Aberdeen, UK
  1. Correspondence to: R Hansen r.hansen{at}abdn.ac.uk

A 14 year old boy who was normally fit and well presented to his general practitioner with an eight month history of abdominal pain and diarrhoea. The diarrhoea was occurring 7-10 times a day and contained occasional blood and mucus. The patient described his abdominal pain as mild, central, and intermittent in nature, but it could increase in severity. The pain was so significant at times that it had caused problems with school attendance. Recently, he had become more lethargic and had lost weight despite a stable appetite. Of note in his medical history were several presentations to outpatient clinics with vague abdominal pain that settled. He had mild asthma but he was on no medication other than intermittent inhaled bronchodilator. His older sister had Crohn’s disease and another sister had been diagnosed with irritable bowel syndrome.

Initial blood tests undertaken by the GP revealed mild hypochromic anaemia with a haemoglobin concentration of 110 g/l, an elevated platelet count of 493×109/l, an elevated C reactive protein concentration of 38 mg/l, and a raised erythrocyte sedimentation rate of 54 mm/h. Electrolytes and liver function were normal with albumin of 32 g/l. Stool cultures were reported as showing no bacterial growth.

The patient was referred urgently to the paediatric outpatient clinic. On examination in the clinic, he was noted to be slightly pale and had tenderness over his sigmoid area. His anus appeared normal. Height and weight were both on the 50th centile but no earlier measurements were available for comparison.

Questions

  • 1 What are the differential diagnoses and what is the most likely diagnosis in this case?

  • 2 What other clinical features are associated with these conditions?

  • 3 What investigations would you order next?

  • 4 What immediate management would you initiate?

  • 5 What long term treatment needs to be considered? …

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