A Less Common Cause of Recurrent Abdominal Pain and Gastrointestinal Bleeding – Look for Clues

Background and objectives: Recurrent abdominal pain is a common complaint in children, in many cases the symptoms resulting in a functional diagnosis. When gastrointestinal bleeding is associated, a red flag is raised. Complex imagistic procedures are often required to set the diagnosis.

Method and results (case presentation): The authors present the case of a 7 years old boy with recurrent abdominal pain with onset at 2 years of age. In his medical history, he had prior presentations with gastrointestinal (GI) bleeding (rectal bleeding at 2 and hematochezia with severe anemia at 5).

The clinical examination revealed hyperpigmented spots on his lips and oral mucosa. At the time of first presentation in the Department of Pediatrics in “Grigore Alexandrescu” Emergency Children’s Hospital, he associated bilious vomiting and diffuse abdominal pain, with normal stools. The blood tests showed hypochromic, microcytic anemia with low iron levels. The colonoscopy found a rectal polyp with no signs of bleeding and no specific findings on histology.

Two months later he was admitted again with anemia. Upper and lower GI endoscopy again revealed no signs of bleeding. He underwent a capsule endoscopy that found a jejunal polyp. MRI enterography set the diagnosis of intussusception on proximal jejunum. Laparotomy was required and found four intussuscepted areas (jejunal and ileal), secondary to intestinal polyps. The pathology confirmed the diagnosis of Peutz Jeghers syndrome.

Conclusion: Complete clinical examination remains an essential part of a swift diagnosis. Less common causes of recurrent abdominal pain might be discreetly indicated by easily accessible signs.