CLINICAL EXAMPLE OF MANIFESTATION OF PROTEIN-LOSING ENTEROPATHY IN A CHILD WITH GASTRIC AND INTESTINAL BEZOAR

Exudative enteropathy or protein-losing enteropathy (PLE) is a rather rare clinical syndrome in which protein is lost through the gastrointestinal tract. Many acquired and congenital diseases are known that are characterized by excessive loss of serum proteins or impaired absorption of food through the gastrointestinal tract. As a rule, these disorders either damage the intestinal mucosa or block the gastrointestinal lymphatic flow due to obstruction and lymphangiectasia. The aim of our study was to analyse the manifestation of exudative enteropathy in a child with gastric and intestinal bezoar. The presented clinical case demonstrates that the development of exudative enteropathy with bezoar of the stomach and intestines in a 7-year-old girl significantly worsened the course of the disease and debuted with the development of generalized edema (anasarca). When the girl visited the paediatrician, her complaints were rather nonspecific: vomiting after eating, pain in the lower extremities, abdominal enlargement, fatigue, headache, shortness of breath when walking. It is known from the anamnesis that 7 days before the appearance of the above complaints, the girl was inpatient with a diagnosis of acute gastroenterocolitis with symptoms of vomiting and loose stools. The child's condition rapidly deteriorated: edema appeared on the legs, face and trunk, oliguria developed and the girl was hospitalized in the intensive care unit. The examination revealed hypoproteinemia, hypoalbuminemia, anemia, decreased calcium, iron and vitamin D3 deficiency. The girl was also diagnosed with impaired protein-synthetic liver function on the background of reactive hepatitis. The complex application of modern examination methods (MRI, CT, endoscopy) allowed us to establish the diagnosis of trichobezoar of the stomach and intestines. The girl underwent surgery and was discharged in a satisfactory condition under the supervision of a paediatrician. This case demonstrates the choice of optimal tactics in the diagnosis and surgical treatment of a child with a large trichobezoar. Due to the efforts of an interdisciplinary team involving endoscopists, functional diagnostics doctors, and pediatric surgeons in the treatment protocol, the risk of complications of this pathology associated with protein and micronutrient loss was reduced. Despite the rarity of such cases, doctors should be alert to the management of these patients. When analyzing the clinical case, the basic principles of bioethics and the patient's personal information were preserved.