Powdered infant formula containing poorly soluble powdered milk may form amorphous globules within the intestine with bowel obstruction. Infants with decreased intestinal motility may be at increased risk.
Clinical features:
(1) usually involves a premature infant, but may occur in a full-term infant who has had surgery or been ill
(2) presents with evidence of intestinal obstruction
(3) history of being fed on a formula with a high concentration of powdered milk
(4) may have palpable intestines
(5) evacuation of hardened, putty-like curd pellets after barium enema
Radiographs of abdomen:
(1) opaque (gray to white) amorphous, round to elongated intraluminal masses surrounded by a zone of air and lacking a fluid level
(2) barium enema shows a narrow colon with rounded intraluminal filling defects
Differential diagnosis:
(1) meconium ileus (frothy masses or non-opaque ground glass appearance on radiographs)
(2) intestinal atresia
Management:
(1) A Gastrografin enema may be effective in relieving the obstruction.
(2) Some infants may develop an intestinal perforation and require surgical repair.
