A Case of Suspected Gastrointestinal Allergy Requiring Emergent Laparotomy for Fecal Ileus

Abstract

A 1-year-old girl was referred to our hospital because of acute colon ileus. She presented with abdominal distension and compensated shock. Abdominal CT showed moderate ascites, thickening of the rectum and sigmoid colon, bowel distension from the ileum to the descending colon, and fecal impaction at the sigmoid descending colon junction. She was suspected as having gastrointestinal allergy because of her clinical history. Colonoscopy was performed under general anesthesia to avoid laparotomy, but it was impossible to release the ileus. Finally, laparotomy was performed, and the feces impacted at the sigmoid descending colon junction was removed from the incised colon wall, and then decompression of the proximal colon was performed by colonoscopy. Because eosinophilic infiltration was found in the sigmoid colon wall during the operation, gastrointestinal allergy was thus strongly suspected. She successfully recovered after the operation and left the hospital 18 days after surgery. A recurrence of ileus due to the same cause was observed 3 months later, but she was successfully treated conservatively. Although most cases of gastrointestinal allergy are treated by pediatricians, initial treatment by pediatric surgeons is sometimes required. As a result, laparotomy is sometimes necessary to effectively treat such cases.