Milk plug syndrome

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Classification according to ICD-10
P76.2 Intestinal obstruction in newborns due to concentrated milk
ICD-10 online (WHO version 2019)

The Milchpfropfsyndrom is a bowel obstruction in neonates by a Laktobezoar in the lower small intestine due to thickened milk, mostly in artificial food.

Synonyms are: English Inpissated-milk syndromes; Milk curd syndrome; Smythe's syndrome; Colonic milk curd obstruction

In 1959 Richard S. Wolf and James Bruce described an operation on a lactobezoar.

The description as a clinical picture comes from the year 1969 by the English children's surgeons RCM Cook and PP Rickham.

The name refers to the South African doctor Patrick M. Smythe together with BJ Dremin and S. Cywes and their report from 1970 as "Inspissated milk syndrome"

Occurrence

The syndrome is very rare. Mostly premature babies are affected from a few days to several weeks old. After it had largely disappeared in the meantime, it is more common again with the better survival of extremely premature babies. Usually the birth weight is less than 1000 g and the gestational age less than 28 weeks. The male sex seems to be affected more often.

root cause

The syndrome only occurs in infants who are not breastfed and fed cow's milk supplements. The reasons discussed are the high proportion of fat, protein and calcium, existing dehydration and immaturity of the small intestine in premature and newborn babies.

Clinical manifestations

Clinical criteria are:

  • normal meconium evacuation
  • ileus of the small intestine after a few days under milk feeding
  • possibly migration peritonitis

There is a risk of intestinal perforation due to pressure ulcers.

diagnosis

Clinically and by imaging, there is an echogenic mass in the right lower abdomen. There are also discolored stools .

Differential diagnosis

The meconium ileus and the meconium plug syndrome must be distinguished .

therapy

Treatment consists of enemas .

literature

  • Marcel Bettex (ed.), Max Grob (introductory), D. Berger (editing), N. Genton, M. Stockmann: Pediatric Surgery. Diagnostics, indication, therapy, prognosis. 2nd, revised edition, Thieme, Stuttgart / New York 1982, p. 7.58, ISBN 3-13-338102-4
  • A. Jain, SV Godambe, S. Clarke, PC Chow: Unusually late presentation of lactobezoar leading to necrotising enterocolitis in an extremely low birthweight infant. In: BMJ Case Reports. Volume 2009, 2009, S., doi: 10.1136 / bcr.03.2009.1708 , PMID 21789104 , PMC 3028062 (free full text).
  • S. Wagener, D. Cartwright, C. Bourke: Milk curd obstruction in premature infants receiving fortified expressed breast milk. In: Journal of pediatrics and child health. Volume 45, Number 4, April 2009, pp. 228-230, doi: 10.1111 / j.1440-1754.2008.01460.x , PMID 19426380 .
  • ER Flikweert, ER La Hei, YB De Rijke, K. Van de Ven: Return of the milk curd syndrome. In: Pediatric surgery international. Volume 19, Number 9-10, November 2003, pp. 628-631, doi: 10.1007 / s00383-003-0968-7 , PMID 14600769 .
  • A. Karkiner, G. Temir, M. Hoşgör, C. Günşar, I. Karaca: Ceacal perforation in a premature newborn infant complicating milk curd syndrome: case report. In: The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology. Volume 14, Number 2, June 2003, pp. 148-150, PMID 14614645 .

Individual evidence

  1. ↑ a b Willibald Pschyrembel : Clinical Dictionary , 266th, updated edition, de Gruyter, Berlin 2014, ISBN 978-3-11-033997-0 , keyword: "Milk plug syndrome"
  2. ↑ a b c Bernfried Leiber (founder): The clinical syndromes. Syndromes, sequences and symptom complexes . Ed .: G. Burg, J. Kunze, D. Pongratz, PG Scheurlen, A. Schinzel, J. Spranger. 7., completely reworked. Edition. tape 2 : symptoms . Urban & Schwarzenberg, Munich et al. 1990, ISBN 3-541-01727-9 .
  3. ↑ RS Wolf, J. Bruce: Gastrotomy for lactobezoar in a newborn infant. In: The Journal of pediatrics. Volume 54, Number 6, June 1959, pp. 811-812, doi: 10.1016 / s0022-3476 (59) 80150-5 , PMID 13655177 .
  4. ↑ RC Cook, PP Rickham: Neonatal intestinal obstruction due to milk curds. In: Journal of pediatric surgery. Volume 4, Number 6, December 1969, pp. 599-605, doi: 10.1016 / 0022-3468 (69) 90486-2 , PMID 5395743 .
  5. ↑ BJ Cremin, PM Smythe, S. Cywes: The radiological appearance of the "inspissated milk syndrome"; a cause of intestinal obstruction in infants. In: The British journal of radiology. Volume 43, Number 516, December 1970, pp. 856-858, doi: 10.1259 / 0007-1285-43-516-856 , PMID 5536676 .
  6. ^ A b A. C. Longardt, A. Loui, C. Bührer, M. Berns: Milk Curd Obstruction in Human Milk-Fed Preterm Infants. In: Neonatology . Volume 115, number 3, 2019, pp. 211-216, doi: 10.1159 / 000494625 , PMID 30646004 .
  7. ^ A b B. Albayrak, S. Horsch, RB Tröbs, C. Roll: Colonic milk curd obstruction in an extremely low birthweight infant. In: Archives of Disease in Childhood. Fetal and neonatal edition. Volume 99, number 3, May 2014, p. F237, doi: 10.1136 / archdischild-2013-304185 , PMID 24062520 .
  8. ^ JW Lohn, RC Austin, MC Winslet: Unusual causes of small-bowel obstruction. In: Journal of the Royal Society of Medicine. Volume 93, number 7, July 2000, pp. 365-368, doi: 10.1177 / 014107680009300707 , PMID 10928024 , PMC 1298061 (free full text) (review).
  9. ↑ T. Watanabe, M. Takahashi, S. Amari, M. Ohno, K. Sato, H. Tanaka, M. Miyasaka, Y. Fuchimoto, Y. Ito, Y. Kanamori: Olive oil enema in a pre-term infant with milk curd syndrome. In: Pediatrics international: official journal of the Japan Pediatric Society. Volume 55, number 4, August 2013, pp. E93 – e95, doi: 10.1111 / ped.12082 , PMID 23910816 .