Neanatal Intestinal Obstruction

To explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant. Five newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan[ the State Food and Drug Administration-instrument (Im.) 2007-NO.2661620]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged. All the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0.9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula, or intestinal obstruction. After pulling out the tube, the symptoms disappeared and then the patient was discharged. One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration, the symptom disappeared. In the 5 cases, the shortest hospital stay was 10 days and the longest was 22 days, the average stay was 16 days. Three to 5 days after operation the weight restored to birth weight, the weight had increased, when discharged, to an average of 5.5 g (kg·d). The small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.

This study aimed to determine the type of neonatal intestinal obstruction, their mortality, and the significance of the direct causes of death. A retrospective study of all neonates managed for neonatal intestinal obstruction (total number studied was 161 child) at Basrah Children's Specialty Hospital (BCSH) between June 2012 and June 2014. Data were collected from patients’ hospital records (neonatal intensive care unit) and analyzed for age, sex, clinical features, diagnosis, surgical procedure performed, prematurity, birth weight, duration of symptoms, complications and their management. The mortality due to neonatal intestinal obstruction is still high in our setting (25.5%). The significant factors associated with mortality were prematurity, birth weight, sepsis; reoperation, short bowel syndrome, and proximal intestinal stoma. Certain causes of neonatal intestinal obstruction were associated with high mortality e.g. jejunoileal atresia (52.6%), meconium ileus (50%), perforated viscus (46%), and duodenal atresia. Male are affected more than female with M:F ratio of 2.4:1. The most common cause of intestinal obstruction in neonates in this series was anorectal malformations (33.5%). Other causes of neonatal intestinal obstruction included Hirschsprung’s disease (24.2%), small intestinal atresias (11.8%), intestinal malrotation with or without volvulus (9.3%), perforated viscus (8.1%), meconium ileus (7.5%), duodenal aresia (2.5%), annular pancreas (1.2%), and meconium plug syndrome, necrotizing enterocolitis and segmental dilatation (0.6%, each). In conclusion, neonatal intestinal obstruction is a common cause of admission accounting for 28.2% of all admission. Mortality from intestinal obstruction is still high in our society and strict measures regarding prenatal, natal and postnatal management should be addressed to save those neonates.

Background: Paediatric intestinal obstruction is a common surgical emergency and is associated with lots of morbidity and mortality especially in developing countries. Paediatric intestinal obstruction differs from adult intestinal obstruction in terms of aetiology, presentation, management and outcome. This study reports the demography, diagnosis, management and outcome of paediatric intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Methodology: This was a retrospective study of paediatric patients who presented with intestinal obstruction to the paediatric surgical unit of Enugu State University Teaching Hospital (ESUTH) Enugu, South East Nigeria. Children above one month of age but below 15 years, who presented with symptoms and signs of intestinal obstruction, were recruited for the study. Intestinal obstruction in neonates was excluded from this study. The study period was for one year, from January 1^st 2018 to December 31^st 2018. Result: During the period of the study 45 cases, 30 (66.7%) males and 15 (33.3%) females were managed. The mean age of the patients was 52.2 months. Abdominal pain was the most common presenting symptom and intussusception was the most common cause of intestinal obstruction. Forty two patients (93.3%) did well and were discharged. Two patients (4.4%) died while one patient (2.2%) was discharged against medical advice. Conclusion: Intussusception was the most common cause of intestinal obstruction in the current study. The mortality of 4.4% recorded in this study can be improved upon.

Neonatal bowel obstruction is one of the most common surgical emergencies in neonates in daily clinical practice. Because most causes of bowel obstruction in neonates are different from those in older children and adults, a clear understanding of the specific causes and how to properly evaluate them is important for optimal care. Imaging evaluation plays an essential role in initial workup, accurate diagnosis, and proper guidance of subsequent management in these patients. This up-to-date article provides radiologists with a practical imaging approach and techniques for evaluating neonatal bowel obstruction. The spectrum of underlying causes of neonatal upper and lower bowel obstruction is discussed using a pattern-based approach to analyze characteristic imaging findings. The preferred diagnostic imaging modalities and key imaging features to distinguish these causes of obstructions from other differential diagnoses are highlighted.

Congenital origin intestinal obstruction are important disease due to required emergency operation. So accurate and rapid diagnosis is needed for decreased mortality and morbidity. Radiologist must detect to accurate obstruction site and also associated other congenital anomalies. And also embriological bases are very important role to the diagnosis of theses diseases. We were analysed radiologically and clinically 25 cases with congenital origin intestinal obstruction with review of literature. 1. Hypertrophic pyloric stenosis 6 cases, midgut malrotation 4 cases, congenital megacolon 8 case, imperforated anus 5 cases, ileal atresia 1 case and duodenal atresia 1 case. 2. Male and female radio were 16:9. Especially on hypertrophic pyloric stenosis, 5 cases were male infants. 3. All cases of hypertrophic pyloric stenosis represented string sign and also pyloric beak sign shoulder sign on UGI. 4. I case duodenal atresia showed double bubble sign on simple abdomen x-ray and ileal atresia showed mechanical small bowel obstruction sign with microcolon. 5. On midgut malrotation, cecum was located in right upper abdomen on 4 cases. And 2 cases were associated with Ladd's band. I case with volvulus and 1 case with mesenteric defect. 6. Involved site of all congenital megacolon were localized to rectosigmoid colon. 7. On 5 cases imperforated anus, 3 cases were low type and 2 case high type. Rectoperineal and rectourogenital fistula were demonstrated on 4 cases.

Gastric diverticulum causing gastric outlet obstruction in the setting of duodenal atresia

The differentiation between congenital causes of neonatal bowel obstruction, such as ileal atresia and Hirschsprung disease, is paramount for appropriate surgical planning. While clinically similar, their radiological findings can overlap, creating significant diagnostic challenges. Ileal atresia is a congenital anomaly characterized by the incomplete development of the ileum, resulting in intestinal obstruction. The aim of this study is to highlight the limitations of contrast studies in neonatal bowel obstruction and to reinforce the principle that in the face of discordant clinical and radiological evidence. We present the case of a full-term female neonate, born at 39 weeks of gestation, who developed symptoms of green vomiting and delayed bowel movements on her second day of life. An initial colon in loop contrast study at eight days of age was suggestive of short-segment Hirschsprung disease, showing a narrowed rectal lumen and a transition zone in the rectosigmoid region. However, due to persistent signs of distal bowel obstruction, surgical exploration was performed on the ninth day of life. Intraoperatively, the diagnosis was revised to Type 3A ileal atresia located 20 cm from the ileocecal junction, with significant adhesions. The management involved adhesiolysis, resection of the atretic ileal segment, and a primary ileo-ascending anastomosis. The postoperative course was complicated by hypovolemic shock and suspected sepsis neonatorum, which were managed successfully with intensive care support, including intravenous antibiotics and parenteral nutrition. The patient showed significant improvement by the fifth postoperative day and was discharged with normal gastrointestinal function. In conclusion, this case underscores a critical diagnostic pitfall where the 'microcolon of disuse' in distal ileal atresia radiologically mimicked the transition zone of Hirschsprung disease. It highlights that while contrast studies are invaluable, a high index of clinical suspicion and readiness for surgical exploration are essential for accurate diagnosis and timely intervention in complex cases of neonatal bowel obstruction.

General considerations ■ Atresias can occur at any level of the gastrointestinal tract ■ Atresias result most likely after mesenteric vascular accidents caused by intrauterine intussusception, volvulus or internal hernia ■ No extraintestinal-associated anomalies are consistently present ■ Jejunoileal atresia is the most common cause of congenital intestinal obstruction in newborns (incidence 1:1000 live births) ■ About 35% of jejunoileal atresia patients are significantly premature ■ Differential diagnosis of jejunoileal atresia includes: meconium disease, meconium plug syndrome, malrotation, Hirschsprung’s disease, and intussusception ■ Colonic atresia is a rare congenital disorder (comprises 5%–10% of all intestinal atresias) ■ Differential diagnosis of colonic atresia includes: malrotation with volvulus, meconium disease, Hirschsprung’s disease, and megacystis hypoperistalsis syndrome

The causes of neonatal bowel obstruction are variable and dominated by malformations and the Meckel diverticulum must remain exceptional. We report a case of neonatal bowel obstruction in a six day old male neonate admitted on account of inability to pass stool, abdominal distension and bilious vomiting. The radiologic additional examinations are non-specific. Exploratory laparotomy found obstruction at the site of a Meckel's diverticulum.

Introduction: Intestinal obstruction is a common cause of abdominal surgery in the neonate. Diagnosis is straightforward using standard radiology, and surgical technique depends on the underlying anatomical lesion. Peritoneal dialysis (PD) is an effective, albeit invasive, therapy for neonatal renal failure. We report a case of neonatal obstruction with severe renal failure treated by PD to highlight our hospital practice and possible remedies in a context of limited resources. Case Presentation: This was a female neonate of moderate prematurity admitted on day 4 of life for management of a flat neonatal obstruction. Radiological diagnosis suggested small bowel atresia. Biological tests revealed severe renal failure with creatinine levels of 416 micromoles per liter and blood urea of 27.1 micromoles per liter. Management consisted of preoperative peritoneal dialysis for 48 hours followed by laparotomy. The intraoperative diagnosis was GROSFELD type IIIa digestive atresia. The postoperative course was favourable, transit was resumed on day 5 and the patient returned home on day 12. Progress at 3 months was satisfactory. Conclusion: Neonatal intestinal obstruction with renal failure in premature infants is associated with a poor prognosis, even more so if there is a delay in treatment. Peritoneal dialysis seems to be a suitable alternative for this management in our working conditions with limited resources.

Association of duodenal atresia (DA) with gastric duplication cyst is an extremely rare entity. Furthermore, DA type III with the presence of distal bowel gas is very rare. We report the case of a 13-day-old preterm male with neonatal intestinal obstruction. Radiological evaluation revealed duodenal obstruction at the second part with the presence of few distal bowel gas shadows. Laparotomy revealed dilated gastroduodenum, atypical malrotation, and a cystic structure (duplication cyst) identical to the stomach attached to its greater curvature along with type III atresia of the second part of the duodenum. Duodenotomies revealed the presence of bile along with air at either blind ends of the duodenum which could be explained by the presence of bile duct duplication at the distal end. We propose that this association is due to “defective mesenchyme formation during organogenesis,” which may explain multiple duplication abnormalities and DA.

Neonatal occlusion of the small intestine and colon is dominated by malformative etiologies.

Purpose: Hirschsprungs disease is common cause of intestinal obstruction in neonate and trans-anal pull through has drastically changed the treatment of Hirschsprungs disease. The aim of this study was to evaluate the short and long-term outcome of single-stage trans-anal pull through in neonates and infants. Material and methods: It was a prospective study of new-born’s and young infants with features of Hirschsprungs disease. Patients with weight more than 3 kg, transition zone at recto sigmoid and distal sigmoid region were included in the study. Patients with more dilated proximal colon, bowel obstruction not responding to washes and long segment Hirschsprungs disease were excluded from the study. Single-stage trans-anal pull through was done in all cases and short term variables include wound infection, leak, peri-anal excoriation and long term outcome variables included continence, constipation, stricture, enterocolitis and need of redo pull-through procedure were evaluated. Results: 24 patients were included in the study. There were 15 males and 9 females. Age of the patients ranged from 26 days to 4.5 months with mean age of 1.3 months. Weight of the patients ranged from 3 kg to 5.3 kg with mean weight of 4.8 kg. Wound infection and perianal excoriation was seen in 8.3% and 45.8% respectively. Enterocolitis, stricture, constipation and minor soiling were seen in 12.5%, 4.2%, 8.3% and 12.5% respectively. Follow-up period ranged from 10 to 120 months. Conclusion: Trans-anal pull through is feasible and safe option with excellent results in neonates and infants with short segment Hirschsprungs disease.

BackgroundTeratomas are rare in neonates. They are embryonic neoplasms containing elements from all the three germ layers. Commonly, they arise in the ovary and testis. Rarely do they arise from the gastrointestinal tract, as in our case. Intestinal obstruction in neonates is usually due to congenital obstructive malformation such as atresia and/or stenosis of the gastrointestinal tract with or without sepsis.Case presentationAn outborn 5-day neonate, generally well before admission presented with non-bilious vomiting, abdominal distension and a palpable mass extending from the right to left flank across the centre. Bilious aspirates/vomiting usually indicates obstruction distal to the ampulla of Vater. Clear aspirates indicate obstruction proximal to the ampulla which usually present by second day of life.Possibility of a mass lesion such as a “teratoma” causing gastrointestinal obstruction needs a high index of suspicion. Imaging studies of plain X-ray chest with abdomen enhanced our clinical suspicion which was promptly followed by ultrasonography of the abdomen and thereafter computerized tomography of the abdomen which provided corroborative evidence. Laparotomy on the seventh day of life confirmed the clinical suspicion and imaging evidence of an exogastric mass arising from the postero-inferior wall of the stomach along its greater curvature. Histopathology revealed a mature teratoma.ConclusionA high index of clinical suspicion by the paediatrician/neonatologist attending a neonate with abdominal distension suggestive of gastrointestinal obstruction, immediate cardiopulmonary, hemodynamic and circulatory stabilization, followed by prompt and appropriate imaging studies with timely surgical consultation holds the key to quality outcome.

Bezoars are an unusual cause of acute intestinal obstruction in children. Most cases are trichobezoars in adolescent girls who swallow their hair. Lactobezoars are another unusual but occasionally reported cause...