Intestinal malrotation with suspected cows milk allergy: A case report

Abstract

Background: Intestinal malrotation is an incomplete rotation of the intestine. Failure to rotate leads toabnormalities 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 cows milk. Several studies have described infants with surgical gastrointestinal diseases and cows 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 cows 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 cows 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 cows milk challenge test. After the patient began feeding on cows 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 cows milk intake after discharge, we concluded that the present case was not the result of a cows milk allergy. At 1 year, the patient showed favorable growth and development, and serum allergy investigations revealed no reaction to cows milk. Conclusion: When physicians encounter infants with surgical gastrointestinal disease, including intestinal malrotation, they should consider cows milk allergy as a differential diagnosis or complication and should utilize food challenge tests for a definitive diagnosis. © 2012 Matsuki et al.; licensee BioMed Central Ltd.