Gastric lactobezoar - a rare disorder?

Area of Science:

• Pediatric Gastroenterology
• Infant Nutrition
• Diagnostic Imaging

Background:

• Gastric lactobezoar is a rare condition causing gastric outlet obstruction in infants, with few cases reported since 1986.
• Clinical presentation often mimics acute abdomen, including distension, vomiting, and abdominal masses, with potential respiratory and circulatory compromise.

Purpose of the Study:

• To review the clinical presentation, pathogenesis, diagnosis, and management of gastric lactobezoars.
• To highlight the challenges in diagnosis and emphasize the need for improved diagnostic sensitivity.

Main Methods:

• Review of 96 reported cases of gastric lactobezoars.
• Analysis of clinical manifestations, proposed pathogenetic factors, and diagnostic imaging techniques.

Main Results:

• Common symptoms include abdominal distension (61.0%), vomiting (54.2%), and diarrhea (21.9%).
• Multifactorial pathogenesis involves infant milk composition (high casein, MCTs, caloric density) and infant immaturity (GI function, dehydration).
• Abdominal ultrasound is the current diagnostic method of choice, detecting echogenic air trapping; however, initial diagnosis is frequently missed.

Conclusions:

• Gastric lactobezoar diagnosis requires high suspicion and experienced interpretation of imaging, as it is often overlooked.
• Effective management involves cessation of oral feeding, IV fluids, and gastric lavage, successfully resolving over 85% of cases.
• Further research into diagnostic sensitivity and optimized management strategies is warranted due to the disorder's low reporting rate.