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Medicina
Croatian Medical Association - Rijeka branch
ISSN: 0025-7729
Vol. 45, No. 2, 2009, pp. 187-191
Bioline Code: me09025
Full paper language: Croatian
Document type: Research Article
Document available free of charge

Medicina, Vol. 45, No. 2, 2009, pp. 187-191

 hr Hijatalna hernija i nenapredovanje na težini u dvogodišnjeg dječaka
Petrić, Tamara & Barbarić, Irena


Cilj: Nenapredovanje na težini mogu uzrokovati razna stanja, a klinička slika vrlo je raznolika. Najčešći uzrok je malapsorpcija, dok su ostali uzroci vrlo rijetki. Cilj ovog prikaza je istaknuti važnost uobičajenog dijagnostičkog postupka kod malapsorpcijskog sindroma.
Prikaz slučaja: Prikazali smo slučaj trinaestomjesečnog dječaka sa simptomima gastrozofagealne refluksne bolesti i nenapredovanja na težini. Laboratorijski su nalazi pokazali anemiju, endoskopija gornjeg dijela probavnog sustava krvarenje iz želučanog vrijeda u hijatalnoj herniji, a kontrastna radiološka pretraga potvrdila je hijatalnu herniju. Unatoč antiulkusnom liječenju i hiperkalorijskoj prehrani dijete nije napredovalo na težini. Učinjena je uobičajena dijagnostička obrada i dokazana celijakija.
Rasprava: Hijatalna hernija u dječjoj dobi vrlo je rijetka i najčešće asimptomatska. U djece sa simptomima koristi se medikamentozno liječenje. Paraezofagealna hernija je rijedak tip hijatalne hernije, a uz nju su češće komplikacije poput volvulusa i inkarceracije. Celijakija je čest malapsorpcijski sindrom (1%). Očituje se nenapredovanjem na težini i tipično se javlja u ranoj dječjoj dobi. Jedino uspješno liječenje jest doživotna bezglutenska dijeta.
Zaključak: Budući da je celijakija jedan od najčešćih uzroka nenapredovanja na težini u dječjoj dobi, ističemo važnost uobičajenih dijagnostičkih testova u sve hipotrofične djece unatoč prisustvu nekog drugog uzroka.


hijatalna hernija, malapsorpcijski sindrom, nenapredovanje na težini

 
 en Hiatal Hernia and Failure to Thrive in a 2-Year-Old Boy
Petrić, Tamara & Barbarić, Irena

Abstract

Aim: Failure to thrive constitutes a broad spectrum of diseases with multiple etiologies and a variety of clinical manifestations. The most common cause is malabsorption while other causes are very rare. The aim of this report is to emphasise the importance of usual diagnostic approach.
Case report: We present a 13 month old boy with symptoms of gastroesophageal reflux disease and failure to thrive. Laboratory findings showed anaemia, upper endoscopy active bleeding from acute ulcer in hiatal hernia and X-ray study confirmed hiatal hernia. Despite drug therapy and hypercaloric nutrition he did not gain weight. We performed usual diagnostic procedure and confirmed coeliac disease.
Discussion: Hiatal hernia in children is very rare and usually asymptomatic. Children with symptoms respond well to drug therapy. Paraesophageal hernia is very rare but with more complications such as volvulus and incarceration. Coeliac disease is the most common cause of malabsorption in children (1%). The typical symptom is failure to thrive because of gluten ingestion and the only therapy is life long gluten free diet.
Conclusion: As coeliac disease is a very common cause of failure to thrive in children, it is important to perform usual diagnostic tests in every hypothrophic child in spite of presence of other possible causes.

Keywords
failure to thrive, hiatal hernia, malabsorption syndrome

 
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