Neonatal lactobezoar (milk curd syndrome): a case report

Abstract

Introduction

Lactobezoar or milk curd syndrome (MCS) is a rare cause of neonatal small bowel obstruction (SBO). Its incidence has decreased with the reduced use of formula rich in calcium and fat, but sporadic cases continued to be reported.

Case presentation

A full-term newborn with a birth weight of 3500 g was brought to the emergency room on day 26 of life due to respiratory distress and a two-day history of feeding intolerance, progressive abdominal distension and multiple episodes of bilious vomiting. The baby had primarily been fed cow's milk, along with intermittent formula. Following initial resuscitation in the intensive care unit, an abdominal x-ray was obtained, which showed dilated bowel loops, multiple air fluid levels, and ground glass appearance in right iliac fossa. He underwent an ultrasound (US) study of the abdomen which ruled out a midgut volvulus. The patient was taken to the operating room for an emergency laparotomy. We found clear ascites, a normal jejunum, and a severely dilated ileum and colon. The lumen of the ileum and colon was full of curd-like contents, or lactobezoars. The bowel wall also had pneumatosis intestinalis. The intraluminal contents were evacuated through gentle manual forward milking. No bowel resection was needed. The baby was started on broad-spectrum antibiotics covering both gram-negative and anaerobic organisms. The baby was kept NPO for 3 days, and enteral feedings with breast milk were started on day 4 and advanced as tolerated. The recovery was uneventful, and the baby was discharged home on day 5. He continues to do well on follow-up.

Conclusion

Even though its incidence has decreased significantly with formula modifications, lactobezoars (or milk curd syndrome) should be included in the differential diagnosis of newborns who develop acute intestinal obstruction.