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Intolerance to an extensively hydrolysed formula mistaken for postoperative diarrhoea in a child with neuroblastoma.

BACKGROUND
Persistent diarrhoea has recently been reported as a common problem following surgical resection for advanced abdominal neuroblastoma.


CASE STUDY
A 10-month-old child, who had previously had no nutritional problems whilst undergoing chemotherapy treatment for a stage IV neuroblastoma, developed severe diarrhoea following tumour resection. He required nutritional support and was commenced on a continuous overnight nasogastric feed of a non-milk protein hydrolysate feed (MCT Pepdite 0-2, S.H.S. International Ltd, UK) His diarrhoea persisted and it was assumed that this was a postoperative problem which in time would regress. Two months later the child was admitted with a rectal prolapse, and a colonoscopy and biopsy suggested allergic protocolitis. The diarrhoea resolved rapidly on stopping the feed.


CONCLUSION
Although he was never re-challenged with the non-milk protein hydrolysate, it appears that he had a rare intolerance to an extensively hydrolysed protein formula which was masked by the assumption that his diarrhoea was a postoperative problem.