Small left colon syndrome

Falterman, L.G. and Richardson, D.J. (1980) Small left colon syndrome associated with maternal ingestion of psychotropic drugs. J Pediatr 97 300-310. 

The clinical presentation of patients with small left colon syndrome is very similar to that of patients with meconium plug syndrome. Air-fluid levels are often absent in the upright film, particularly prior to 48 h of life. Soap bubble meconium is typically seen in the collapsed left colon on the plain film, and the distended bowel tends to be less than that seen in atresias. The contrast enema reveals a normal or slightly dilated colon and rectum but... 

Fig. 1.34. Small left colon syndrome. Isosmolar water-soluble contrast enema in a newborn with low obstruction demonstrates a normal rectum and distal rectosigmoid and a relatively narrow proximal sigmoid and descending colon with a transition to a more dilated colon at the splenic flexure. In 1 week radiographic and clinical signs of obstruction resolved...

The differential diagnosis in the neonatal period is that of small left colon syndrome. In this condition the left colon is a reduced calibre, typically, from the level of the splenic flexure distally, with an abrupt transitional zone between the dilated transverse colon and the narrow calibre descending colon. These findings are visible right from the first few days of life in small left colon syndrome, but would not typically be present in Hirschsprung s disease for some delayed period. 

Historically meconium plug syndrome and small left colon syndrome have been considered as separate, if possibly overlapping, entities. The main finding in both entities is that of a narrow recto-... 

Berdon WE, Slovis TL, Campbell JB et al (1977) Neonatal small left colon syndrome its relationship to agan-glionosis and meconium plug syndrome. Radiology 125 457-462... 

Functional Immaturity of the Colon (Small Left Colon and Meconium Plug Syndrome) 207... 

Lactose intolerance can either be the result of a primary deficiency of lactase production in the small bowel (as is the case for Deria Voider) or it can be secondary to an injury to the intestinal mucosa, where lactase is normally produced. The lactose that is not absorbed is converted by colonic bacteria to lactic acid, methane gas (CH4), and Hj gas (see figure on left). The osmotic effect of the lactose and lactic acid in the bowel lumen is responsible for the diarrhea often seen as part of this syndrome. Similar symptoms can result from sensitivity to milk proteins (milk intolerance) or from the malabsorption of other dietary sugars. 

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