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Massive intestinal albumin loss after Fontan operation
1Department of Pediatrics, Osaka University Medical School, Japan.
Acta Paediatrica Japonica : Overseas Edition
|June 1, 1991
Summary
Massive intestinal protein loss was diagnosed in a young girl after heart surgery using abdominal scintigraphy. This imaging technique helped pinpoint the protein loss in her lower small intestine, suggesting a condition linked to increased venous pressure.
Area of Science:
- Pediatric Cardiology
- Nuclear Medicine
- Gastroenterology
Background:
- The Fontan operation is a complex surgical procedure for complex congenital heart defects.
- Protein-losing enteropathy (PLE) is a known complication following Fontan procedures.
- Accurate diagnosis of PLE is crucial for appropriate management.
Observation:
- A 9-year-old girl, post-Fontan operation for pulmonary atresia, presented with massive intestinal protein loss.
- Abdominal scintigraphy using technetium-99m (99mTc)-labeled human serum albumin was performed.
- Scintigraphy revealed significant tracer accumulation in the lower small intestine.
Findings:
- The study identified the lower small intestine as the primary site of protein loss.
- Tracer movement was observed from the small intestine into the colon, correlating with intestinal contents.
- This pattern suggests intestinal lymphangiectasia as a potential cause, possibly due to elevated central venous pressure.
Implications:
- Abdominal scintigraphy with 99mTc-human serum albumin is a valuable diagnostic tool for PLE in pediatric patients.
- Early diagnosis and identification of the site of protein loss can guide therapeutic strategies.
- Understanding the link between central venous pressure and intestinal complications is vital for long-term Fontan patient care.