Necrotizing enterocolitis in the setting of milk allergy after pediatric living donor liver transplantation
Necrotizing enterocolitis in the setting of milk allergy after pediatric living donor liver transplantation
复制标题
小儿活体肝移植后牛奶过敏引起的坏死性小肠结肠炎
DOI：
10.1111/petr.13096
复制
发表时间：
2017
影响因子：
1.3
通讯作者：
Kasahara Mureo
中科院分区：
文献类型：
--
作者：
Narumoto Soichi;Sakamoto Seisuke;Uchida Hajime;Sasaki Kengo;Shigeta Takanobu;Fukuda Akinari;Nosaka Shunsuke;Irie Rie;Yoshioka Takako;Kasahara Mureo
NEC是一种特发性肠粘膜损伤，可能进展为透壁性肠坏死，但不伴有肠系膜缺血。NEC通常会影响7 - 10天的新生儿肠道喂养。1例无剖腹手术史的10个月大女孩因急性肝衰竭接受LDLT。术后第5天开始肠内喂养后，患者出现腹胀。弥漫性PVG和PI通过放射学方式检测。剖腹探查术发现肠斑片状坏死，无穿孔。显微镜下发现一个切除标本显示透壁凝固性坏死与多个小血栓符合新生儿NEC的特点，嗜酸性粒细胞浸润也被观察到。随后，在恢复牛奶肠内喂养后，她出现严重腹泻，停止牛奶给药后症状消失。这些临床和病理结果支持NEC可能由CMA诱导的推测。食物过敏，这可能是由免疫抑制剂引起的，应被认为是一个潜在的原因，NEC在设置小儿肝移植。
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.