Expect the unexpected: A case of penetrating Crohn's disease complicated by foreign body ingestion.
In nonverbal autistic teens with worsening Crohn’s, rule out swallowed objects before calling it a flare.
01Research in Context
What this study did
Doctors told the story of one nonverbal autistic teen.
The teen had Crohn’s disease and sudden belly pain.
Scans showed a toy piece stuck in the gut wall.
Surgeons removed the toy and fixed the bowel.
What they found
The pain was not a Crohn’s flare.
It was the toy cutting through the bowel.
After surgery the teen healed well.
The team warned: check for objects before raising Crohn’s meds.
How this fits with other research
Slaughter et al. (2014) and Kang et al. (2014) both show GI pain is common in autism.
Their surveys found pain in up to half of kids.
Those papers urge wider GI screening.
Kline’s case gives the next step: when pain spikes, think of hidden objects too.
Johnson et al. (2009) reviewed 144 studies and found GI reports range from 4 % to 97 %.
That huge spread shows we still miss causes.
A stuck toy is one more cause to add to the list.
Why it matters
If you work with nonverbal youth, sudden behavior change or belly pain may mean an object was swallowed.
Ask parents about missing toys, magnets, or batteries.
Request imaging before assuming a flare of known disease.
Quick action can turn major surgery into a simple scope.
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02At a glance
03Original abstract
A 17‐year‐old nonverbal male with autism spectrum disorder (ASD) presented with abdominal pain, diarrhea, and weight loss. Initial workup revealed penetrating Crohn's disease (CD) with an ileosigmoid fistula and abscess. After initial improvement with antibiotics, enteral nutrition (EN), and infliximab (IFX), he developed recurrent abdominal pain and elevation of inflammatory markers. Repeat imaging suggested disease progression, prompting surgical intervention. During ileocecal resection and fistula takedown, a foreign body (the hand of an action figurine) was discovered, likely contributing to bowel obstruction and abscess recurrence. This case highlights the importance of medical and surgical comanagement of penetrating CD, as well as the need to maintain a broad differential diagnosis when new or worsening symptoms arise.
JPGN Reports, 2025 · doi:10.1002/jpr3.70095