Cow's milk protein allergy presenting with Hirschsprung's disease–mimicking symptoms
Section snippets
Background
A substantial number of neonates present with Hirschsprung's disease (HD)–like symptoms and plain x-ray findings, which, however, respond well to conservative treatment and are associated with no long-term residual gastrointestinal (GI) symptoms. Therefore, once HD is ruled out, little attention is paid to this condition by pediatric surgeons and neonatologists. Unlike other transient functional intestinal obstruction, such as meconium-related ileus [1], this condition occurs mostly in
Definition of BTNIN
Benign transient nonorganic ileus of neonates was defined as nonorganic ileus of neonates excluding HD, HD-allied disorders, and meconium-related ileus [1]. Inclusion criteria for nonorganic ileus were defined as follows: (1) the patient was referred to the Department of Pediatric Surgery of Osaka Medical Center for Maternal and Child Health with suspected HD; (2) an upright plain x-ray showed dilatation of the colon with a diameter greater than that of the lumbar vertebrae, along one third of
Results
Of 26 cases, 9 were diagnosed as HD by manometric studies, which were confirmed by histologic examination of surgical specimens. Seventeen were diagnosed as CMA by the diagnostic criteria. All the cases presented with marked abdominal distention, 7 of them presented with vomiting including 3 cases with bilious vomiting, and severe constipation and poor weight gain were reported in 1 each. The onset of symptoms was within the first 3 days of life in 3, and between 14 and 30 days in the others.
Discussion
Cow's milk allergy is not rare in infancy; epidemiologic studies suggest that CMA affects 2% to 7.5% of infants [6], [7]. However, well-defined syndromes, such as protein-losing enteropathy and colitis, account for only 5% of CMA in infancy [8], and the vast majority of cases of CMA present with poorly defined and diverse symptoms including regurgitation and/or vomiting [9], chronic constipation [10], and allergic colitis [11]. Therefore, GI symptoms caused by CMA are often overlooked because
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Cited by (0)
Presented at the 39th Annual Meeting of the Pacific Association of Pediatric Surgeons, May 14–18, 2006, Taipei, Taiwan.