RESUMO
Adrenal hemorrhage (AH) is a relatively uncommon condition in newborns. It may be asymptomatic or may present with flank abdominal mass, anemia, jaundice, or rarely as scrotal bruising or hematoma. We report two cases of AH in neonates; the first presented with scrotal hematoma and the second with adrenal mass associated with hypertension and oliguria, primarily secondary to coincidental renal vein thrombosis. Diagnosis was confirmed by abdominal ultrasound. Patients were managed conservatively with clinical observation and by following hemoglobin and bilirubin levels closely. Both infants were discharged without surgical intervention after several days in the hospital. Clinicians should consider AH when a newborn presents with scrotal bruising or hematoma, unexplained anemia, unexplained jaundice, or flank abdominal mass. Timely ultrasonographic evaluation of both adrenal glands and testes in neonates with scrotal hematoma may spare infants from unnecessary surgical intervention because scrotal hematoma often raises the suspicion of testicular torsion.
Assuntos
Doenças das Glândulas Suprarrenais , Neoplasias das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais , Hematocele , Hemorragia , Veias Renais , Trombose , Doenças das Glândulas Suprarrenais/complicações , Doenças das Glândulas Suprarrenais/diagnóstico , Doenças das Glândulas Suprarrenais/fisiopatologia , Doenças das Glândulas Suprarrenais/terapia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Assistência ao Convalescente , Anemia/diagnóstico , Anemia/etiologia , Tratamento Conservador , Diagnóstico Diferencial , Feminino , Hematocele/diagnóstico , Hematocele/fisiopatologia , Hematocele/terapia , Hemorragia/complicações , Hemorragia/diagnóstico , Hemorragia/fisiopatologia , Hemorragia/terapia , Humanos , Recém-Nascido , Icterícia/diagnóstico , Icterícia/etiologia , Masculino , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Trombose/complicações , Trombose/diagnóstico , Trombose/fisiopatologia , Trombose/terapia , Resultado do Tratamento , Ultrassonografia/métodosRESUMO
Rectal bleeding in neonates is an alarming sign that suggests a possible serious underlying condition, such as infection or bleeding disorder that would necessitate hospitalization and prompt intervention. We report a case of eosinophilic gastroenteritis caused by cow's milk protein allergy in a one-day- old infant, who presented with frankly bloody stools associated with massive gastrointestinal and peripheral blood eosinophilia prior to initiation of enteral feedings. The patient's outcome was favorable, with complete spontaneous recovery in one week, after a period of bowel rest, parenteral nutrition, and use of amino acid formula. The eosinophilia was also transient and gradually resolving by two months of age. Rectal bleeding secondary to allergic colitis caused by cow's milk sensitization may occur in neonates, and failure to appreciate this possibility may lead to inappropriate diagnostic or therapeutic intervention.
