Protein-Losing Enteropathy

To the Editor: The review of protein-losing enteropathy (PLE) by Ozen and Lenardo (Aug. 24 issue) 1 provides a vivid depiction of the two principal pathologic mechanisms — namely, intestinal mucosa damage and microcirculation drainage failure (Fig. 2 of their article). The list of potential causes, however, seems to neglect a common condition. Specifically, major surgery involves intraoperative stresses that divert blood from the enteric circulation. 2 The decreased perfusion can lead to mucosal ischemia, reduced cellular integrity, and abnormal physiological characteristics (e.g., postoperative lactose intolerance). 3 In addition, postoperative atelectasis may indirectly impair microcirculation and lymphatic drainage. 4,5 Major surgery, therefore, could provoke . . .