Our Case Report Associate Editor Dr. Jeff Malatack shares with us his excitement learned from a case report we are early releasing this month from our January issue:
Protein Losing Enteropathy (PLE) can accompany many varied gastrointestinal pathologies. Dr. Zellos et al. (doi: 10.1542/peds.2011-0937) bring to our attention yet another mechanism causing PLE, malrotation and midgut volvulus. Pediatric surgeons and pediatricians associate malrotation and midgut volvulus with a rapidly progressive abdominal catastrophe due to bowel necrosis, perforation, peritonitis and death unless rapid intervention occurs. The authors report a much more indolent course in a toddler with failure to thrive, hypoalbuminemia, hypogammaglobulinemia and generalized edema, whose malrotation was severe enough to obstruct low pressure vessels including lymphatics and mesenteric veins leading to loss of protein rich lymphatic fluid into the bowel and peritoneum but not severe enough to obstruct high pressure mesenteric arteries. Consequently, no bowel necrosis occurred nor did rapid progression of symptoms expected in volvulus. Once recognized and corrective surgery undertaken, the volvulus was reduced causing the patient’s albumin to increase as the PLE resolved. Put this chronic low grade midgut volvulus on the list of causes of PLE.
Our Case Report Associate Editor Dr. Jeff Malatack shares with us his excitement learned from a case report we are early releasing this month from our January issue:
