[Congenital anatomic gastrointestinal obstruction: prenatal diagnosis, morbidity and mortality]

The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda

Background

Bowel obstruction is a common surgical emergency in newborns. One-fourth of neonates with obstruction suffer postoperative complications, with high mortality, especially in low-income countries. Factors attributed to mortality include prematurity, late presentation and associated multiple congenital anomalies. The prevalence and the predictors of mortality in our setting have not been well studied. We aimed to describe the early postoperative outcomes and to determine the predictors of mortality among neonates with bowel obstruction.

Methods

We conducted a prospective cohort study during 4 months, when we recruited postoperative neonates from the pediatric surgery unit of Mulago Hospital. We collected data on demographics, clinical presentations, maternal characteristics, the surgical procedure performed, postoperative outcomes, etc. After follow-up for 2 weeks, we analyzed the data using Cox proportional hazards regression models of predictors of mortality.

Results

A total of 76 neonates were recruited, with a male-to-female ratio of 2.2:1. The age ranged from 1 to 26 days, a median of 3 [interquartile range (IQR): 2, 7]. About 67.1% had birth weights ranging between 2.5 kg and 3.5 kg, a mean of 2.8 [standard deviation(SD)=0.64]; 76.3% were termed; with anorectal malformation (ARM), 31.6% as the leading cause, followed by jejunoileal atresia (JIA), 25%. Nearly 55.3% of neonates developed complications; 53.9% with post-operative fever, 15.8% had wound sepsis. The mortality rate was 44.7% (34/76) and was highest among cases of JIA, 41.2%. The predictors of mortality included prematurity, fever at admission, breastfeeding status, and mother’s parity as well as the cadre of healthcare providers (p<0.005).

Conclusions

ARM is the predominant cause of bowel obstruction among neonates, followed by JIA. The morbidity and mortality due to bowel obstruction among neonates are unacceptably high. The major predictors of mortality were prematurity, fever at admission, and the cadre of the healthcare providers.

A rare case report of infant ileal atresia with double appendix

INTRODUCTION

Small bowel atresia has quite an incidence in infants particularly in males. It is usually seen to be the most common cause of bowel obstruction in neonates since birth. It may be associated with other congenital anomalies.

PRESENTATION OF THE CASE

A 4 day old neonate presented with abdominal distension, billous vomiting & non passage of stools since birth. On further examination, it was seen that the abdominal distension was mostly central & there was hyperperistaltic bowel sounds on auscultation. The infant also had scoliosis. There was decreased appetite & features of dehydration. Diagnosed by USG(W/A), infantogram & X-Ray plain picture abdomen.

DISCUSSION

The mortality from the atresia of ileum is greater owing to the incidence of early perforation. Infants may present with features discussed above. They usually present during the 1st week of life but majority of the babies presenting late have significant mortality. Early surgical intervention with excision of the dilated bowel segment with anastomosis of the proximal (normal caliber bowel) to the distal part of the bowel has been seen to have been associated with decreased morbidity & mortality.

CONCLUSION

It has been observed that one of the many causes for neonatal intestinal obstruction is attributed to small bowel atresia. This has been associated with successful outcome depending on the presentation of the child to the hospital to the timing of surgical intervention along with resuscitation & starting of enteral feeds. Small bowel atresia can be associated with antenatal morbidity in the mother as cited here.

Neonatal Intestinal Obstruction: A 15 Year Experience in a Tertiary Care Hospital

INTRODUCTION

Neonatal intestinal obstruction is the most common surgical emergency in a newborn requiring prompt intervention. There are only very few studies done in world regarding pattern of neonatal intestinal obstruction.

AIM

This study was conducted to see the aetiological spectrum of neonatal intestinal obstruction and to find out the problems and outcome of surgical management.

MATERIALS AND METHODS

This study was done retrospectively to include all operated cases of neonatal intestinal obstruction from June 2000 to May 2015 and various factors affecting outcome were analysed.

RESULTS

A total of 298 newborns were included in the study. Male-female ratio was 1.8:1. Gestational age was variable from 32 to 42 weeks (mean = 37.5 weeks) and birth weight from 1.4 to 3.5kg (mean= 2.25 kg). Mean age of presentation was 6 days with intestinal atresia (49.6%) as the commonest cause. Other causes were Hirschsprung (13%), Malrotation gut (11.7%), Meconium ileus (7.3%), patent VID (5%), duodenal obstruction (4%), duplication cyst (3.7%), obstructed hernia (2.7%) and others (2.7%). Mortality rate was 16.4% with sepsis both pre as well as post operative as the main cause of mortality.

CONCLUSION

The morbidity and mortality of neonatal intestinal obstruction has improved over last few years mainly due to antenatal detection, early intervention, meticulous resuscitation before surgery along with good NICU care.