Intestinaler Laktobezoar – seltene Ursache einer intestinalen Obstruktion im Kindesalter

Background Milk curd syndrome (MCS), also referred to as milk curd obstruction (MCO) or lactobezoar (LB), is a rare gastrointestinal condition that primarily affects preterm infants with very low or extremely low birth weight. It is typically associated with formula feeding or fortified human milk. While most cases of LB involve the stomach, an intestinal localization is exceedingly rare, particularly in term infants. Case presentation We report the case of a 4.5-week-old term male infant who was presented with a right-sided irreducible inguinal hernia and signs of mechanical ileus. Laparoscopic reduction revealed a hemorrhagic but viable bowel segment. The patient was re-admitted 2 months later with symptoms of mechanical bowel obstruction. Exploratory laparotomy revealed an intraluminal mass in the terminal ileum. Segmental resection was performed and histological examination confirmed the diagnosis of an ileal LB.

The formation of MCS is attributed to multifactorial causes, including immature gastrointestinal function, dehydration and diverse nutritional factors. Although gastric LBs have been more frequently reported, ileal involvement is rarely documented, especially in term infants. This highlights the importance of also considering an ileal LB as a differential diagnosis in cases with signs of an intestinal obstruction, even outside the typical risk group.

Ileal lactobezoar is a rare but potentially life-threatening cause of neonatal intestinal obstruction. Prompt recognition and surgical management are critical for a favorable outcome. Literatur Longardt AC et al (2019) Milk Curd Obstruction in Human Milk-Fed Preterm Infants. Neonatology 115(3):211–216. https://doi.org/10.1159/000494625 Stanger J et al (2014) Human milk fortifier: an occult cause of bowel obstruction in extremely premature neonates. J Pediatr Surg 49(5):724–726 Wirmer JH et al (2023) Ileus Due to a Lactobezoar in an Infant. Dtsch Arztebl Int 120(45):767–767 Elkhouli M (2022) Ileal lactobezoar in extreme premature infant complicated by intestinal perforation: A case report. Int J Surg Case Rep 96:107303 Unusually late presentation of lactobezoar leading to necrotising enterocolitis in an extremely low birthweight infant. Amish Jain. BMJ Case Rep. 2009.1708. Ramírez Díaz R (2024) Fortified milk: a rare cause of intestinal obstruction in pre-term patients. Cir Pediatr 37(3):137–140 Walsh O, Anthony R (2024) Case-control study of milk curd obstruction in newborn infants in a tertiary surgical neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 110(1):102–106 Heinz-Erian P et al (2012) Gastric lactobezoar - a rare disorder? Orphanet J Rare Dis 7:3. https://doi.org/10.1186/1750-1172-7-3 Neonatal Lactobazoar (milk curd syndrome): a case report. Saswati B., Gulshan K.S. et al. Journal of pediatric surgery case reports. 118(6):103034. Sparks B, Kesavan A (2014) Treatment of a gastric lactobezoar with N‑acetylcysteine. Case Rep Gastrointest Med 2014:254741. https://doi.org/10.1155/2014/254741 Klein-Frank A et al (2013) Severe anemia in 3 toddlers with gastric lactobezoar. Klin Padiatr 225(3):159–163. https://doi.org/10.1055/s-0033-1334897 Flikweert ER et al (2003) Return of the milk curd syndrome. Pediatr Surg Int 19(9-10):628–631 Iwamuro M et al (2015) Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc 7(4):336–345 Bos M (2013) Gastric pneumatosis and rupture caused by lactobezoar. Pediatr Int 55(6):757–760 Gambart M et al (2012) Gastric perforation caused by a lactobezoar in an infant: a case report. Arch Pediatr 19(9):927–931 Karkiner A et al (2003) Ceacal perforation in a premature newborn infant complicating milk curd syndrome: case report. Turk J Gastroenterol 14(2):148–150 Bajorek S, Basaldua R (2012) Neonatal gastric lactobezoar: management with N‑acetylcysteine. Case Rep Pediatr 2012:412412 Wagener S, Cartwright D, Bourke C (2009) Milk curd obstruction in premature infants receiving fortified expressed breast milk. J Paediatr Child Health 45(4):228–230 Michael A, Sellaraman SSellaraman (2004) Lactobezoar: a rare cause of ileal obstruction. Indian Pediatr 41(12):1279–1280 Corzine M (2011) Radiology case study. Gastric lactobezoar. Neonatal Netw 30(3):180–187 Kashish K, Vikram K, Anjan D, Veereshwar B (2017) Milk Curd Syndrome: A Forgotten Entitity. Adv Res Gastroentero Hepatol 4(2):555635 L., Castro A., Berenguer C., Pilar R., Goncalves J. L., Nunes (2014) (2014) Recurrent gastric lactobezoar in an infant Oxford Medical Case Reports 2014(4) 80-82 https://doi.org/10.1093/omcr/omu031 M, Prahl D, Smetana N, Porta (2014) Lactobezoar formation in two premature infants receiving medium-chain triglyceride formula Journal of Perinatology 34(8) 634-635 https://doi.org/10.1038/jp.2014.78 Dimitrios A., Savva MacKenzie, Crist Allison, Lardieri (2019) N-Acetylcysteine for Gastric Lactobezoars in a 1-Month-Old The Journal of Pediatric Pharmacology and Therapeutics 24(3) 247-250 https://doi.org/10.5863/1551-6776-24.3.247 R Ramírez Díaz, I Ibarra Rodríguez, G M Gavilanes Salazar, C Moreno Hurtado, M R Chamorro Juárez Fortified milk: a rare cause of intestinal obstruction in pre-term patients. Cir Pediatr. 2024 Jul 9;37(3):137-140 Jonathan, Durell Nigel J, Hall Melanie, Drewett Kujan, Paramanantham David, Burge (2017) (2017) Emergency laparotomy in infants born at Saswati Behera et al. Neonatal lactobezoar (milk curd syndrome): a case report. Journal of Pediatric Surgery Case Reports Volume 118, July 2025, 103034 Förderung Keine. Author information Authors and Affiliations Corresponding author Ethics declarations Interessenkonflikt Die Angaben zum Interessenkonflikt orientieren sich am Formular des International Committee of Medical Journal Editors (ICMJE). Y. Isaev und A. Worm haben keinerlei Unterstützung für das vorliegende Manuskript erhalten. Sie erklären, dass für die letzten 36 Monate keinerlei Beziehungen, Tätigkeiten und Interessen offenzulegen sind, die mit dem Inhalt des Manuskripts in Zusammenhang stehen. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patient/-innen zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern/Vertreterinnen eine schriftliche Einwilligung vor. Additional information Redaktion Thomas Lücke, Bochum Ertan Mayatepek, Düsseldorf Ute Spiekerkötter, Freiburg Norbert Wagner, Aachen Stefan Wirth, Wuppertal Hinweis des Verlags Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral. QR-Code scannen & Beitrag online lesen Rights and permissions About this article Cite this article Isaev, Y., Worm, A. Intestinaler Laktobezoar – seltene Ursache einer intestinalen Obstruktion im Kindesalter. Monatsschr Kinderheilkd (2026). https://doi.org/10.1007/s00112-026-02355-5 Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s00112-026-02355-5