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Necrotizing enterocolitis in the setting of milk allergy after pediatric living donor liver transplantation
Author(s) -
Narumoto Soichi,
Sakamoto Seisuke,
Uchida Hajime,
Sasaki Kengo,
Shigeta Takanobu,
Fukuda Akinari,
Nosaka Shunsuke,
Irie Rie,
Yoshioka Takako,
Kasahara Mureo
Publication year - 2018
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13096
Subject(s) - medicine , necrotizing enterocolitis , exploratory laparotomy , parenteral nutrition , liver transplantation , gastroenterology , pneumatosis intestinalis , laparotomy , necrosis , enteral administration , coagulative necrosis , surgery , transplantation , perforation , fulminant , materials science , punching , metallurgy
NEC is an idiopathic intestinal mucosal injury that may progress to transmural bowel necrosis without mesenteric ischemia. NEC usually affects 7‐ to 10‐day‐old neonates following enteral feeding. A 10‐month‐old girl with no history of laparotomy underwent LDLT for acute liver failure. After starting enteral feeding on postoperative day 5, she developed abdominal distention. Diffuse PVG and PI were detected by radiologic modalities. Exploratory laparotomy revealed patchy necrosis of the intestine without perforation. The microscopic findings of a resected specimen revealed transmural coagulative necrosis with multiple small thromboses compatible with neonatal NEC features, and eosinophil infiltration was also observed. Subsequently, after the resumption of enteral feeding with cow's milk, she developed severe diarrhea, the symptoms of which were eliminated after the administration of cow's milk was stopped. These clinical and pathological findings support the speculation that NEC might have been induced by a CMA. Food allergies, which can be induced by immunosuppressive agents, should be considered as a potential cause of NEC in the setting of pediatric liver transplantation.