High suspicion unveils Hidden pathology of pediatric gastrointestinal surgical cases misidentified as medical: Three case reports

Abstract

BACKGROUND

Gastrointestinal diseases in young children are often anatomic or inflammatory in nature and can present with symptoms similar to those of Cow’s milk protein allergy (CMPA), complicating diagnosis. This case series highlights 3 pediatric patients initially misdiagnosed with CMPA, emphasizing the need for a thorough evaluation.

CASE SUMMARY

Case 1: A 3-year-old child with chronic abdominal distension and constipation was initially treated for CMPA and was later diagnosed with Hirschsprung disease through rectal biopsy. Surgical intervention involved a laparoscopic colostomy followed by a pull-through procedure, leading to a successful recovery. Case 2: A 2-month-old infant presented with greenish-yellow vomiting and abdominal distension. Initially misdiagnosed with CMPA, further investigation using barium studies revealed partial intestinal malrotation. The patient underwent a laparoscopic Ladd’s procedure and recovered well. Case 3: A 6-month-old infant with persistent vomiting and failure to thrive had been treated for CMPA. Detailed imaging studies indicated achalasia. The child underwent a Heller myotomy, which resulted in significant symptom improvement and weight gain

CONCLUSION

Thorough evaluation of gastrointestinal symptoms is necessary in children. A high suspicion for alternative diagnoses will prevent delays in accurate diagnosis and proper treatment, leading to improved outcomes.

Keywords: Pediatric surgical cases; Cow’s milk protein allergy; Gastrointestinal obstruction; Hirschsprung’s disease; Intestinal malrotation; Achalasia; Case report

Core Tip: This case series highlights the importance of differential diagnosis in pediatric gastrointestinal cases. In this case series, 3 pediatric patients were initially misdiagnosed with cow’s milk protein allergy, leading to a delay in timely and appropriate surgical interventions. A thorough evaluation and a high suspicion for alternative diagnoses, including Hirschsprung’s disease, intestinal malrotation, and achalasia, are crucial for improving patient outcomes for children.