Page 220 - Abstract Book KONIKA 18

Gastroenterohepatology

P-GEH-020
Characteristics of Cytomegalovirus Hepatitis in Children: 5-Year Experience
at A Tertiary Children’s Health Center in Jakarta

Syahminar Rahmani, Eva Jeumpa Soelaeman, Ariani Dewi Widodo
Gastrohepatology Division, Department of Child Health, PKIAN RSAB Harapan Kita, Jakarta, Indonesia

Abstract
Background Minimal information is available in the medical literature on hepatic manifestations,
complication, and prognosis of CMV. Objective To evaluate the clinical characteristics, laboratory data,
and prognosis of children with CMV hepatitis at PKIAN RSAB Harapan Kita as tertiary medical center for
women and children. Methods Retrospective study including 35 children diagnosed with CMV infection
based on specific markers (anti-CMV IgM and IgG, and CMV avidity). Clinical manifestation, biochemical
characteristics, and outcomes of CMV hepatitis were determined. Results The median age of subjects
(n=35) was 3 months (1-8 months). Jaundice (100%) was the most common clinical feature of CMV
hepatitis in infancy. Twenty-five subjects (74.1%) showed failure to thrive. The median levels of aspartate
aminotransferase (AST) and alanine aminotransferase (ALT) were 195 (range 22-1175) U/L and 115 (range
15-980) U/L. The median levels of total bilirubin and gamma GT were 10.3 (range 0.16-46.83) mg/dL and
131 (range 11-904) U/L. The hematologic findings revealed anemia (51.4%). All subjects were treated
with ganciclovir for 2 weeks. Immediate improvement of ALT and AST were identified in 17 subjects. The
median duration of ALT and AST improvement was 2 months (1-13 months) after treatment. Conclusion In
children with CMV hepatitis, jaundice was the most common clinical manifestation. Liver panel test revealed
high AST, ALT, serum bilirubin, and gamma GT. Normal levels of AST and ALT were mostly achieved in
2 months after ganciclovir treatment. Further research should be conducted to evaluate more data on the
outcomes of CMV hepatitis.
Keywords: cytomegalovirus hepatitis; children; clinical manifestation; prognosis

P-GEH-021
Midgut Malrotation: Clinical Case Approach Using ROME IV Criteria

Wira Febrisandi Irsan, Muzal Kadim
Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Abstract
Background Vomiting is a coordinated reflex movement to expel stomach contents through the mouth,
usually preceded by nausea. Management of vomiting is generally supportive and the challenge is to
distinguish between organic or functional disorders. Based on ROME IV criteria, vomiting caused by
functional impairment should not be accompanied by other medical conditions or alarm signs. Objective
To demonstrate the importance of using ROME IV criteria for the management of a child’s vomiting. Case
A 1 year and 4 months old boy diagnosed with functional cyclic vomiting with cyproheptadine therapy at
previous admission, is now admitted to ER with a chief complaint of bilious vomiting in the last 12 hours.
He had a very short stature, inadequate weight gain, and recurrent vomiting which had occurred since 5
months old. The patient had exploratory laparotomy for intussusception and laparoscopic adhesiolysis for
duodenal stenosis due to adhesions at age of 5 months and 1 year old respectively. Plain Anteroposterior &
Lateral abdominal X-ray in the previous admission showed no obstruction, hence barium meal procedure
was conducted in recent admission, revealing severe gastric distension and stenosis duodenum pars I-II.
Midgut malrotation was found intraoperatively. Conclusion ROME IV criteria using alarm signs and other
medical conditions to distinguish organic or functional causes of vomiting in children. The initial diagnosis
was functional cyclic vomiting but evidence of bilious vomiting and inadequate weight gain warrant further
evaluation. A barium meal procedure was conducted, revealing gastric distension and duodenal stenosis.
Keywords: vomiting; ROME IV; midgut malrotation

172 KONIKA XVIII Abstract Book