Case Presentation: Hyperbaric oxygen therapy (HBOT) has been considered a promising modality of treatment for inflammatory bowel disease (IBD) wound treatment. Over the past decade, there has been a rising number of case reports in the adult population demonstrating its safety and efficacy, and a 2021 systematic review found that HBOT was safe and well tolerated in patients with IBD, however descriptions of this treatment modality in the pediatric population are still lacking.10yo boy presenting with one month of diarrhea, hematochezia, fecal incontinence, fever, abdominal pain and rectal pain, found to have a perianal ulcerated lesion on exam confirmed by tissue biopsies as Crohn’s disease. Pelvic MRI revealed a fistula originating at the distal anal canal, extending inferiorly to the medial aspect of the left buttock. He was started on weekly adalimumab, prednisolone, metronidazole, ciprofloxacin and regular sitz baths, with improvement of his diarrhea and abdominal pain, however persisted with severe rectal pain and large ulceration that was exacerbated by bowel movements and significantly interfered with his ability to sit comfortably. Given these symptoms did not improve with initial medical management, diverting ostomy was considered, however a shared decision with the family was made to attempt HBOT in an effort to avoid stoma surgery. Patient underwent eleven 90-minute sessions of HBOT at 2.4 atmospheres, with two 5-minute air breaks, leading to significant improvement of the rectal pain and significant healing of the perianal lesion. He continued medical treatment over the following months. He was able to wean off steroids and while maintaining symptom control.
Discussion: Crohn’s disease is characterized by transmural inflammation of the gastrointestinal tract, leading to severe complications, such as fistulizing disease. Diverting ostomy surgery is often required for patients with non-healing perianal fistulas, which can significantly interfere with daily activities and quality of life. HBOT can trigger tissue restorative pathways which contribute to wound healing, and thus might represent a promising approach for the management of perianal fistulas. Further studies are needed to better elucidate the effectiveness of HBOT, the optimal treatment duration and which clinical scenarios would benefit the most from it.
Conclusions: This case represents an example of successful treatment of severe fistulizing ileocolonic Crohn’s disease employing HBOT. Our case study supports the idea that HBOT can act as a valuable treatment modality for perianal fistulas in the setting of Crohn’s disease in the pediatric population, with the potential to prevent the need for diverting ostomy surgery, leading to decreased morbidity and better quality of life.