Department of Pediatric Gastroenterology and Nutrition, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
J Pediatr Surg. 2011 Dec;46(12):2332-5. doi: 10.1016/j.jpedsurg.2011.09.028.
Cow's milk allergy (CMA) can cause functional bowel symptoms. This can lead to confusion and difficulty in managing pediatric surgical patients who also have CMA. We examined CMA's effect on the management of pediatric surgical patients in our institute.
With institutional review board approval, 14 pediatric surgical patients with CMA were reviewed. Cow's milk allergy was diagnosed according to clinical findings and stimulation index (normal range <300%) of the lymphocyte stimulation test.
The main symptoms were abdominal distension (n = 10), vomiting (n = 6), constipation (n = 2), and apnea (n = 1). Stimulation index median value was 731% (range, 341%-2132%). Patients were divided into 3 groups. In group 1 (n = 8), persistent postoperative bowel symptoms were initially considered related to surgical diseases. Following CMA diagnosis, CM elimination therapy improved symptoms. In group 2 (n = 4), CMA was diagnosed concurrently with surgical disease, and elimination therapy was continued postoperatively. In group 3 (n = 2), the pathogenesis of bowel symptoms was initially attributed to CMA and later diagnosed as Hirschsprung's disease.
A high index of suspicion regarding the possibility of concurrent CMA may be necessary to manage bowel symptoms in pediatric surgical patients.
牛奶过敏（CMA）可引起功能性肠症状。这可能导致对同时患有 CMA 的儿科手术患者的管理产生混淆和困难。我们检查了 CMA 对我院儿科手术患者管理的影响。
经机构审查委员会批准，回顾了 14 例患有 CMA 的儿科手术患者。根据临床发现和淋巴细胞刺激试验的刺激指数（正常范围<300%）诊断牛奶过敏。
主要症状为腹胀（n = 10）、呕吐（n = 6）、便秘（n = 2）和呼吸暂停（n = 1）。刺激指数中位数为 731%（范围为 341%-2132%）。患者分为 3 组。在第 1 组（n = 8）中，最初认为持续性术后肠症状与手术疾病有关。在诊断出 CMA 后，CM 消除疗法改善了症状。在第 2 组（n = 4）中，同时诊断出 CMA 和手术疾病，并在术后继续进行消除疗法。在第 3 组（n = 2）中，肠症状的发病机制最初归因于 CMA，后来诊断为先天性巨结肠。
对于儿科手术患者的肠症状管理，可能需要高度怀疑同时存在 CMA 的可能性。
