Unusually late presentation of lactobezoar leading to necrotising enterocolitis in an extremely low birthweight infant.

The present report concerns a case of unusually late presentation of lactobezoar, or inspissated milk curd obstruction, leading to necrotising enterocolitis (NEC) in an extremely low birthweight (ELBW) boy infant, born at 26 weeks gestation with a birth weight of 750 g. He deteriorated acutely on day 84 of postnatal age (corrected age 38 weeks) needing intermittent positive pressure ventilation (IPPV). Over the next 3 days he developed signs of NEC, though a radiograph showed no diagnostic features. In view of increasing abdominal distension, silent abdomen and increasing ventilatory requirements, an emergency exploratory laparotomy was performed. The laparotomy revealed inspissated milk curd obstruction in the terminal ileum. There was also a small area of NEC at the ileocaecal valve. A limited hemicolectomy was performed with creation of an ileostomy and mucous fistula. Following this procedure his clinical status improved. Feeds were reintroduced after 7 days and he was on full enteral feeds by 14 days.