Distented stomach

Question

My daughter is 2 years old and was born with a meconium ileus. Therefore the diagnosis of CF was made very quickly. She has had an artificial anus that has been reposed. Since then she suffers from an extremely distended abdomen, in the ultrasound you see very very much air in the stomach and bowels. What can be the reasons for that and what can be done?

Answer

Hello,
because of the meconium ileus, the part of the small bowel before the stop (which is caused by thickened meconium) had been distended. Because of the artificial anus, as a rule, such a distension resolves again so that after reposition of the artificial anus the transport of the stool in the bowel is normally unproblematic. In some cases it takes the bowel some time (adjusting phase) to regain a normal transport function. In that phase it comes quite frequently to a distended abdomen and increased flatulence. As a rule, parts of the small bowel are distendend because of accumulation of secretions and air (flatulence), but not the stomach.
In that adjusting phase having normal stool regularly and without any problems as well as normal thriving of the child is of imminent importance. If the doctor in charge of your CF-centre is also of the opinion that the stomach of your child is unusually distended, an x-ray imaging with constrast medium of the small bowel (fractional gastrointestinal passage) should be done to your child in order to get an impression of the function of the bowel at the site of the anastomosis (the site where the bowel has been sewed together again).
Another problem that might cause a distended abdomen could be an impaired digestion of food, especially of the fat component due to the CF illness of your daughter. For a more specific answer, information about stool quality, quantity and frequency is needed. Tests could be done to check the digestion of fat and to determine if replacement of pancreatic enzymes is adequate. Please talk about that to the doctors of your CF-centre.
In general, one has also to take into account that children at the age of 2 often still have quite weak abdominal walls, so that the stomach can appear distended without necessarily representing an illness.

Yours sincerely,
Dr. H.-G. Posselt

08.07.2008