Deficiency of intestinal gas in infants with diarrhea; a presentation of three cases.

Abstract

The presence of moderate amounts of air in the small bowel loops is a normal finding in infants. The newborn infant swallows air with its first breath, and gas can be demonstrated by roentgenograms in the sigmoid colon usually in two to five hours (6, 14, 15). Complete absence of gas in the small bowel, or in the stomach and small intestine, as shown roentgenographically, is commonly interpreted as a sign of high obstruction and of grave significance. There is little in the literature to indicate that complete absence of gas in the infant bowel occurs under any other circumstances. In 3 cases to be presented here this finding was associated with severe diarrhea and dehydration without any mechanical obstruction. Severe diarrhea with resulting dehydration is not a true disease of infants, but rather a sign accompanying disease. In many instances it can be attributed to specific bacterial or viral causative agents (2–5, 7, 10, 13). As is well known, however, it may be due to parenteral infection elsewhere in the body, septicemia, or a host of other conditions. It is beyond the scope of this paper to delve into the causes of infantile diarrhea, nor is it necessary to emphasize its seriousness. The roentgen findings in infants with diarrhea have not received a great deal of attention in the literature, perhaps because the physical findings are obvious and biochemical studies are the important factors in determining the therapeutic measures and following the progress of the condition. The statement that in severe infantile diarrhea the abdomen is distended and the general picture may resemble ileus is frequently encountered (1, 3, 8). Loops of small bowel distended with gas in infants with diarrhea are commonly seen whenever abdominal films are taken in such cases. We were not familiar, however, with the picture of a relatively gasless abdomen in this condition, and a review of the literature failed to disclose any recorded cases. Case Reports Case I: B. F., an apparently healthy male infant, was born at the University of Minnesota Hospitals. Delivery was uncomplicated. The weight at birth was 3,620 gm.; cry and respiration were spontaneous. During the first thirty-six hours glucose and water feedings were tolerated and a meconium stool was passed. Three days after birth, however, the infant, who up to that time was taking his feedings normally, began to regurgitate all supplements and refused the breast. Two green stools were passed. The weight had fallen to 3,170 gm., and the child showed signs of dehydration and jaundice. The abdomen was flat and soft; peristalsis was thought to be normal. A supine film revealed a small amount of gas in the stomach but none in the small or large intestine (Fig. 1). The picture was that commonly seen in pyloric stenosis or obstruction of the duodenum.