Infant Botulism Initially Presenting as a Bowel Obstruction

Abstract

Infant botulism is a rare but serious neuromuscular condition affecting infants 2 weeks to 1 year of age. Infant botulism is caused by C. botulinim which colonizes the GI tract and releases a toxin that binds nerve terminals leading to progressive weakness, hypoventilation, and respiratory failure. Initial symptoms in an infant can be constipation and poor feeding. Our case reports a 10-week-old female presenting with several days constipation and three days of feeding intolerance, and inconsolability initially diagnosed as a bowel obstruction on imaging. Exploratory laparotomy showed no signs of obstruction and infant later developed neurological symptoms which led to suspicion and diagnosis of infant botulism. In our literature review there is no other case of infant botulism presenting initially as bowel obstruction. A differential diagnosis of infant botulism should be considered in infants presenting with signs of bowel obstruction.