M. Golež
Klinični oddelek za neonatologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

S. Mali Brajovič
Klinični inštitut za radiologijo, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

A. Granda
Klinični oddelek za otroško kirurgijo in intenzivno terapijo, Kirurška klinika, Univerzitetni Klinični center Ljubljana, Ljubljana, Slovenija

G. Nosan
Klinični oddelek za neonatologijo, Pediatrična Klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

Abstract

A lactobezoar is a pathological conglomeration of undigested milk and mucus in the intestinal tract of milk-fed children. It is most frequently seen in the stomach of newborns, especially preterms, and results from the coagulation of milk and mucous proteins. The pathogenesis has multiple factors: exogenous influences such as a high content of calories, casein or medium-chain triglycerides in milk formula, as well as endogenous factors including immature gastrointestinal function in premature and/or low birth weight newborns. Clinically, a lactobezoar frequently manifests itself as acute abdomen with abdominal distension and pain or vomiting, or as diarrhoea or a palpable abdominal mass. The diagnosis is based especially on a history of inappropriate milk feeding and signs of acute abdomen, and is easily confirmed by abdominal ultrasound. This shows a multi-layered round or oval mass of low echogenicity, which contains multiple interspersed spots of high echogenicity. These indicate bubbles of trapped air. The mass can be seen floating freely or partially touching the gastric wall. In subsequent ultrasound examinations the mass grows and moves from the fundus to the antrum. X-ray examination of the upper intestinal tract with contrast shows an intra-gastric large circular filling defect. Cessation of oral feeding combined with administration of intravenous fluids and gastric lavage, and sometimes with mucolytic N-acetylcysteine, resolve most neonatal gastric lactobezoars. Laparotomy is rarely needed. The prognosis of lactobezoar is very good; exceptionally there can be serious complications such as intestinal obstruction or perforation.

Key words: bezoars, newborn, infant formula, acute abdomen