Dr. Deepak Patel
Child Health
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
Would a 4-year old child, who is diagnosed with gastroenteritis, show severe inflammation from rectum all the way up to the tail end of the colon? He was diagnosed based on vomiting and diarrhea. His vomit and diarrhea were of the consistency of thick peanut butter and both looked identical. I had never seen vomit or stool that looked liked thick, whipped paste and in very light brown color. He had no fever, no abdominal pain but cried and cried that his butt really hurt. They did a CAT scan thinking it might be his appendix but the CAT scan came back negative but clearly showed an inflamed rectum and lower colon, about 12 inches from the anus.
My little boy was in play therapy for reasons of possible sexual abuse and reported to his therapist six weeks later that he was forced to sleep naked with an adult male and he did not like it. If a small child's anus and rectum suffered trauma, could that result in the child throwing up and defecating this paste type substance? The ER doctor was puzzled because he said it was unusual that diarrhea inflamed the entire colon and not the tail end and rectum.
Please advice.
Hi,
Welcome to icliniq.com.
It is really very unfortunate that you are dealing with this problem.
For gastroenteritis to cause such a massive inflammation of colon there should be some associated symptoms like fever or pain in abdomen. Gastroenteritis should have persisted for a longer period of time approximately two weeks to cause such an inflammation. If sexual abuse has been done then there should be some injury marks on the anal region. Sexual abuse would have resulted inacute pain which the child should have told. In my opinion, there could be a chance of sexual abuse which later has resulted or lead to gastroenteritis and subsequently to inflammation of colon and rectal region. I suggest you to get the anal region examined by a surgeon for injury marks. I also think your child needs immediate admission in hospital for three or four days.
I wish your child a good health.
Thank you.
Patient's Query
Hi doctor,
Thank you for your response. I would like to get further clarification that diarrhea did not cause my son's rectum to become severely inflamed, is that correct? The radiologist who performed the CT scan asked the ER doctor to verify if diarrhea was the cause of the proctitis - nowhere in the report was it ever ruled out or was it ever explained why it was there.
Have you ever witnessed a child victim of sexual abuse? My son wets the bed, has nightmares and told his therapist that he has secrets with this person of interest in this matter and also has hiding places and licks his lips raw from anxiety. All these things combined, with the CT scan you reviewed. Please tell me what you see from a professional and biological point of view. I need to make sure my son is safe.
Hi,
Welcome back to icliniq.com.
Yes, I have seen a number of cases of sexual abuse in children. Sexual abuse is a common cause of proctitis and in all these cases there were external injury marks at the perianal region. Due to sexual abuse or more clearly anal penetration, sexually transmitted diseases may occur like gonorrhea, chlamydia, syphilis and herpes infection. These infections have similar picture of proctitis. There are other causes like gluten sensitivity in which there should be a history of diarrhea on and off for five to six months but is not present in your child. Your child has night terrors and he remembers of some person who has involved in this act while talking to therapist also points towards sexual abuse. Now we can clarify the diagnosis, in my opinion a stool test result for sexually transmitted diseases can clear the picture and a rectal biopsy in which a small tissue is taken for examination will help in a clear diagnosis. Sexual abuse is very traumatic for a child. I advise you to fully investigate the matter so that further incidents can be stopped.
Wishing your child good health.
Take care.
Patient's Query
Hi doctor,
It is highly unlikely that my son has a sexually transmitted disease. This occurred only once and had never happened before and has not reoccurred. So one last time I want to clarify something;
In your medical opinion, and having worked with children and witnessed child victims of sexual abuse, the psychology of remarks made to his therapist combined with the physical findings, as well as a video of him saying that this person of interest rubbed his penis on stomach and that he pees on him "again and again and again", would you interpret that all combined, as sexual abuse to a toddler?
Hi,
Welcome once again to icliniq.com.
I am very sure that gastroenteritis cannot lead to proctitis. Gastroenteritis is a common problem in children but I have not seen proctitis in any case of gastroenteritis. If sexual abuse is there, then there must be sexually transmitted diseases to cause such proctitis, so it must be ruled out by investigations which I had stated you earlier. A four year child is not able to tell all the things that had happened, so we have to look at all the things to make the diagnosis. I advise you not to ask the child again and again because some traumatic memories may persist in adulthood. In my opinion, considering the psychology of remarks of therapist with the physical findings of proctitis, this appears to be a case of sexual abuse; the only thing lacking is external injuries which should be present in similar cases like this. If in investigations, sexually transmitted diseases are proved then sexual abuse is a sure possibility. If and if all sexually transmitted diseases are ruled out then only we can say that there is no physical abuse. So, I suggest you to wait for the result of investigations to come. Just try to build confidence in child, it is also very necessary.
Wishing your child good health.
Take care.
Patient's Query
Hello doctor,
I did not discuss this with my child. The biggest problem I face is that there was no physical examination done for my son. I made a mistake regarding what the ER doctor said he presented with; they noted it was "proctocolitis," not "proctitis." Can you please explain to me the difference between these two? As I tried to research this, the two kept being intertwined and used one and the same definition to describe the symptoms. Would you please clarify the difference between them?
I fear, without any physical examination at that time, that it cannot be said with certainty what occurred. That is why I need to know what else, besides a gluten problem, could or would have caused his rectum to become so inflamed; he did not have a gluten problem or bouts of diarrhea. Even the diarrhea was not really diarrhea but was like a soft paste stool; his vomit was thick and looked identical to his stool; I had never seen anything like that. If you had been the doctor in the ER Room looking at this CT Scan, would you have examined him right then and there based on what you were looking at, and would you have diagnosed that as being caused by gastroenteritis?
I must find answers to the "why" this was present and rule out any other possibilities without a physical examination before I can act further on this.
Thank you.
Hi,
Welcome back to icliniq.com.
I have read your question in detail and know you are very concerned for your child.
Proctocolitis is a term used for inflammation of the rectum and colon. In proctitis, there is inflammation of the anus with inflammation of the last six inches of the rectum; in proctitis, there is no inflammation of the colon.
Proctocolitis does not have an association with anal abuse. It is primarily infective in nature, like infection by Chlamydia trachomatis, LGV (Lymphogranuloma Venereum), Neisseria gonorrhoeae, HSV, and Campylobacter species. In contrast, proctitis is associated with sexual abuse and sexually transmitted infection such as lymphogranuloma venereum and herpes proctitis.
The CAT scan report you mentioned stated a very inflamed rectum and lower colon, about 12 inches from the anus. Still, it is tough to comment on a single picture of a CAT scan showing how much the colon is inflamed and whether the rectum is inflamed. If there had been any physical examination at the initial emergency room (ER) examination, we would have certainly known whether any injury marks or tears were present at the anal region. Since there is no history of on-and-off diarrhea in your child, and stool is like a soft paste, we can easily rule out celiac disease as a cause.
The vomiting that was thick and like a paste could be due to temporary obstruction at the intestinal level, which I am sure will relieve as symptoms decrease and inflammation subsides.
If I were in the ER Room and upon looking at this CT Scan report, I would have definitely examined the anal region and immediately asked for a surgery specialist's opinion right away, as this would have made the diagnosis 100 % clear.
To conclude:
If the CAT scan images and doctor's opinion is of proctocolitis, and if there are no injury marks at the anal region, we can lower the possibility of sexual abuse. Since your child has no on-and-off loose stool problem, we can rule out the possibility of celiac disease.
I would like to know the results of sexually transmitted infections in your child, as it will help make a precise diagnosis. I sincerely advise you to make the child calm and give him confidence and try not to discuss anything in front of him. If anal sex has not happened, then also you have evidence of sexual abuse of the child, which can be detrimental to the child's mind, so irrespective of whether there is anal sex or not, the culprit should be punished so that this kind of pathetic things do not happen in future. I would like to know how is your child's health now, how is his mental condition and what are the results of the reports at the hospital.
Wishing for your child's early recovery.
Take care.
Patient's Query
Hello doctor,
Thank you for this detailed explanation; I am very concerned for my son. If this occurred in the absence of everything else, it would have been less worrisome for me. I will never discuss this with my son; he does not open up easily and the walls around him are very high and understandably so, as he had to deal with a lot in his little lifetime.
Hi,
Welcome back to icliniq.com.
You just try to build confidence in your child, and everything will be alright. Do not pressurize yourself so much, as you have done what you could do.
Take care.
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