The expanding infant

A 9-month-old child was seen with a history of diarrhoea of varying severity present for several months. The child had, in addition, developed ankle oedema and swelling around the eyes. On examination the abdomen was soft but distended. The major biochemical abnormality was a low serum albumin (19 g/1). Figure 1 is a plain radiograph of chest and abdomen. Ultrasound showed a normal liver, gallbladder, pancreas and kidneys. Ascites was present. Figure 2 is a transverse scan of lower abdomen, and Fig. 3 is an early radiograph from the barium follow-through.