Intestinal malrotation with suspected cow’s milk allergy: a case report

BMC Research Notes

Naoya Sawa³  Muneyuki Tanabu¹  Yutaka Suzuki¹  Susumu Kanda¹  Akimune Kaga²  Takuma Matsuki² 

[1]Department of Pediatrics, Hachinohe City Hospital, 1 Bisyamontaira, Hachinohe, Aomori, 031-8555, Japan

[2]Department of Pediatrics, Tohoku University School of Medicine 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

[3]Department of Pediatric Surgery, Hachinohe City Hospital, 1 Bisyamontaira, Hachinohe, Aomori, 031-8555, Japan

关键词: Intestinal malrotation;    Infant;    Food challenge test;    Cow’s milk allergy;    Allergen-specific lymphocyte stimulation test;   

Others  :  1165787
DOI  :  10.1186/1756-0500-5-481

 received in 2012-07-21, accepted in 2012-09-01,  发布年份 2012

【 摘 要 】

Background

Intestinal malrotation is an incomplete rotation of the intestine. Failure to rotate leads to abnormalities in intestinal positioning and attachment that leave obstructing bands across the duodenum and a narrow pedicle for the midgut loop, thus making it susceptible to volvulus. One of the important differential diagnoses for malrotation is an allergy to cow’s milk. Several studies have described infants with surgical gastrointestinal diseases and cow’s milk allergy. However, to our knowledge, no study has reported infants with intestinal malrotation who have been symptomatic before surgery was performed and have been examined by allergen-specific lymphocyte stimulation test and food challenge tests with long-term follow-up.

Case presentation

The patient was a Japanese male born at 39 weeks of gestation. He was breast-fed and received commercial cow’s milk supplementation starting the day of birth and was admitted to our hospital at 6 days of age due to bilious vomiting. Plain abdominal radiography showed a paucity of gas in the distal bowel. Because we demonstrated malpositioning of the intestine by barium enema, we repositioned the bowel in a normal position by laparotomy. The patient was re-started on only breast milk 2 days post surgery because we suspected the presence of a cow’s milk allergy, and the results of an allergen-specific lymphocyte stimulation test showed a marked increase in lymphocyte response to kappa-casein. At 5 months of age, the patient was subjected to a cow’s milk challenge test. After the patient began feeding on cow’s milk, he had no symptoms and his laboratory investigations showed no abnormality. In addition, because the patient showed good weight gain and no symptoms with increased cow’s milk intake after discharge, we concluded that the present case was not the result of a cow’s milk allergy. At 1 year, the patient showed favorable growth and development, and serum allergy investigations revealed no reaction to cow’s milk.

Conclusion

When physicians encounter infants with surgical gastrointestinal disease, including intestinal malrotation, they should consider cow’s milk allergy as a differential diagnosis or complication and should utilize food challenge tests for a definitive diagnosis.

【 授权许可】

   
2012 Matsuki et al.; licensee BioMed Central Ltd.

【 图 表 】

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