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Lactobezoar is a foreign body produced in the gastrointestinal tract by the presence and accumulation of undigested milk curds. It is seen most commonly in low-birth-weight, premature infants fed with 24-calorie formulas. Conventional therapy includes withholding feedings, repeated gastric lavage, and maintenance of nutrition and hydration by the parenteral route. Most cases respond to this regimen within 48 to 72 hours. We present a case of gastric lactobezoar in a premature, small for gestational age infant who was fed a 24-calorie formula but failed to respond to conventional therapy for more than a week. Historical background and pathophysiology of lactobezoar are discussed.

We report a retrospective review of peptic ulcer disease (PUD) in children seen at Children's Hospital of Michigan, over 10 years (1971-1980). Of the 61 included, 31 had primary ulcers and 30 had stress ulcers. The diagnosis was made by either barium meal or endoscopy, at surgery, or at autopsy. Stress ulcers were commoner in children less than 4 years of age and were precipitated by various conditions leading to shock. The majority of these patients required surgery for perforation or bleeding. Primary ulcers were more common in children older than 4 years. The most common presenting symptoms in this group were abdominal pain and gastrointestinal bleeding. The majority of patients with primary PUD received medical therapy in the form of antacids and/or cimetidine. In one-third of these patients, surgery was necessary for complications such as intractable pain, perforation, or massive recurrent hemorrhage.