Colon Casts Excreted in a Child

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A 6-year-old boy with fever, abdominal pain, refractory diarrhea, and neutropenia (<100 neutrophils/μl) was admitted to our hospital. He had recurrent similar episodes since 2 years age and had been taking prednisolone for symptom relief without success. Exclusive enteral nutrition over a month improved these symptoms. Further, upon refeeding, he rapidly developed severe abdominal pain and shock. After 8 hours, he spontaneously excreted per anus a number of tubular-shaped, brown objects with a parasitic appearance (Fig. 1). These structures were recognized as colon casts, demonstrated as atrophic colonic mucosa by ultrasonography and pathological examination (Figs. 2 and 3). Blood and stool bacterial cultures were negative. He recovered without surgical intervention. At present, the patient is managed well with continued exclusive enteral nutrition. We assume the original disease to be an unidentified autoinflammatory disorder mimicking monogenic IBD, but have not yet detected any genetic defects.
Colon cast is a rare manifestation of intestinal ischemia and acute graft-versus-host-disease (1–4). Catastrophic ischemia and severe inflammation can lead to peeling of the colonic wall mucosa. Surgical resection is required in most patients. However, this case recovered with conservative management alone (1–4). This is the first case report of an excreted colon cast in a child.
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