PP19 EFFECT OF LACTOBACILLUS GG ON TOLERANCE ACQUISITION IN CHILDREN WITH COW'S MILK ALLERGY

Abstract

Results: The diagnosis was obtained with barium enema in 4 patients. The remaining child, operated for intestinal occlusion, at surgery presented a dolicosigma with tight mesenteric root. All patients underwent colic resection with intestinal anastomosis. The resection was performed as emergency procedure in three cases. In two cases, an attempt to resolve the volvulus after barium enema was successful, and the patients were operated electively after having performed anorectal manometry (normal findings in both). Surgical specimens were investigated for aganglionosis, resulting normal in all cases. No post-operative complications were reported. During the follow up (range 20 months – 31 years) one patient presented an episode of intestinal subocclusion, treated conservatively. Discussion: Sigmoid volvulus has to be considered in the differential diagnosis of intense recurrent abdominal pain associated to vomiting and distension. A high index of suspicion is essential in order to perform the diagnostic barium enema or CT scan. Colonic resection (with laparotomic or laparoscopic approach) represents the optimal therapeutic solution, possibly as elective surgery. Considering the risk of intestinal necrosis and peritonitis, a nonoperative approach (decompressive rectal probe, rigid or flexible colonoscopy) is not warranted as a routine. The variable clinical presentation and the possible spontaneous resolution of pain can determine diagnostic delay and errors, responsible for the high mortality reported in adulthood (up to 16% in surgical series and 36% in patients treated conservatively).