A Rare Case of Abdominal Distension

Background: There are several causes of abdominal distension, elongation and dilatation of the colon (dolichomegacolon) is a rare diagnosis in pediatric age.

It may be congenital or acquired; chronic or acute and may lead to intestinal oclusion and perforation of the intestinal wall, resulting in sepsis and risk of death.

Case Report: A 7 month old male child was referred to the paediatric department for abdominal distension, poor weight progression and abundant stools.

First child of young non-consanguineous parents (father with esofagogastric reflux) with no hereditary diseases. His birth and psicomotor development were normal. Under exclusive breast milk up to 4.5 months and because of poor weight (15th centil up to 4 months and 3-15th centil since then) starts infant formula. Introduction of gluten at 6 months. Hospitalization for acute gastroenteritis at 3 months.

On examination he had a distended abdomen, soft on palpation with tympanism. Blood investigations showed anemia (Hb 10,8g/dL), ferritin 27ng/mL and PCR 0,2mg/dL. Hepatic and renal function, total protein and ionogram had normal values, as well as his immunoglobulin concentrations. Celiac disease, cow`s-milk protein allergy, cystic fibrosis and giardisis were excluded.

Upper endoscopy with biopsy (mild degree of esophagitis and gastritis), high resolution manometry, rectoanal inhibitory reflex and sensitivity to rectal distention were normal. Lower gastrointestinal series showed a dolichomegacolon.

He was treated with proton-pump inhibitor, laxatives, probiotics, high-fiber, lactose-free diet.

Conclusion: The dolichomegacolon justifies multiple recurrencies to the emergency room presented with constipation or intestinal suboclusion and has a difficult treatment.