Two Cases of Crohn’s Disease Diagnosed in the Postoperative Course of Anorectal Malformation and Hirschsprung’s Disease

Abstract

Case 1 was a 7-year-old girl who had undergone a cutback procedure for low-type anorectal malformation (ARM) in the neonatal period. Postoperatively, bowel management was maintained with enemas and laxatives. At the age of six, she developed a perianal fistula that was refractory to conservative treatment, and she gradually exhibited poor weight gain. Fecal calprotectin and serum leucine-rich α2-glycoprotein (LRG) levels were elevated, prompting further evaluation, which led to a diagnosis of Crohn’s disease (CD). Case 2 was an 8-year-old boy with total colonic-type Hirschsprung’s disease (HD) who had undergone an ileal pull-through procedure using the Soave technique. Postoperative bowel management included enemas and Nelaton-catheter-assisted decompression. From around the age of six, he began experiencing recurrent abdominal and perianal pain, and by age seven and a half, he developed iron-deficiency anemia. Similarly, elevated fecal calprotectin and serum LRG levels prompted further workup, resulting in a diagnosis of CD. The clinical features of postoperative complications following ARM and HD can closely resemble those of CD, making accurate differentiation challenging. When persistent or refractory symptoms appear, especially in conjunction with systemic findings, a comprehensive evaluation should be undertaken with CD considered as a differential diagnosis.