title: Cow's milk enteropathy: surgical pitfalls.
abstract: BACKGROUND
  Cow's milk-induced intestinal bleeding is a well-recognized cause of rectal bleeding in infancy. The authors report on 5 older children who presented with either visible rectal bleeding or profound anemia associated with occult intestinal bleeding secondary to cow's milk enteropathy.
  
  
  METHODS
  Five children (3 boys and 2 girls) aged between 20 months and 9 years were referred for further investigation of gastrointestinal bleeding. Two had been investigated previously on multiple occasions, and both had undergone laparotomies with negative results. Further investigations showed evidence of allergic colitis in 3 detected only on proximal colonic biopsy findings.
  
  
  RESULTS
  In all cases, bleeding resolved completely after instituting a cow's milk-free diet. Two of the patients subsequently have undergone a cow's milk challenge leading to prompt recurrence of symptoms, which again resolved after simple dietary manipulation.
  
  
  CONCLUSIONS
  Cow's milk enteropathy may cause overt rectal bleeding or profound anemia from occult intestinal bleeding even in older children. Histological abnormalities in such cases may be confined to the proximal colon. After appropriate investigation, a trial of cow's milk exclusion should always be considered before laparotomy for obscure, chronic gastrointestinal bleeding in children.
authors.affiliation: Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, England.
authors.forename: I E
authors.initials: IE
authors.lastname: Willetts
authors.forename: M
authors.initials: M
authors.lastname: Dalzell
authors.forename: J W
authors.initials: JW
authors.lastname: Puntis
authors.forename: M D
authors.initials: MD
authors.lastname: Stringer
mesh_terms: D002675:Child, Preschool; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007223:Infant; D007787:Lactose Intolerance / Q000150:complications*; D008297:Male; D012007:Rectum