A Case of Neonatal Milk Allergy With Hematemesis, Shock, and Hepatic Portal Venous Gasemia

Abstract

We experienced treating a case of neonatal milk allergy presenting with haematemesis, shock, and hepatic portal venous gasemia. The patient was an 8-day-old male infant, born at 39 weeks and 4 days of gestation, weighing 3,020 g. He vomited on day 1 of life and passed a small amount of fresh blood in his stool on day 3. He was observed by a local physician but presented to his previous doctor on day 8 with poor feeding, somnolence, frequent vomiting, and red-brown watery stools. Haematemesis, portal vein gas on plain abdominal radiographs, and intestinal dilatation on contrast-enhanced CT raised suspicion of strangulated bowel obstruction, prompting his transfer to our hospital for emergency surgery. However, ultrasonography and contrast-enhanced CT revealed generalized thickening of the intestinal wall without signs of obstruction or necrosis. On the basis of these findings, milk allergy was suspected, and conservative treatment was initiated. The patient’s symptoms rapidly improved, and allergen-specific lymphocyte stimulation tests showed strong positivity for κ-casein, β-casein, and lactoferrin, confirming the diagnosis of milk allergy. This case highlights the importance of thoroughly evaluating abdominal findings and imaging studies to establish a differential diagnosis, including milk allergy, even in the presence of shock and hepatic portal venous gasemia.