Clinical Presentation and Management of Neonatal Intestinal Obstruction

Abstract

AimsTo find out etiological aspect and outcome of neonatal intestinal obstruction.nbspMaterial and MethodsThis prospective study was conducted over a period of 3 years from February 2016 to January 2019. 60 cases presented with neonatal intestinal obstruction were included in the study. Neonates of Multiple anomalies Necrotising enterocolitis anorectal malformation and esophageal atresia were excluded from the study. Plain x-ray abdomen and Ultrasound scan were done in all cases to rule out renal and other anomalies. Contrast radiography was performed in selected cases. All cases underwent their respective operations depending upon diagnoses.nbspResultsAmong 60 cases 28 neonates had bowel atresia 3 meconium ileus 9 malrotation 15 HD and 5 Meckelrsquos diverticulum. There were 43 males and 17 females M F- 2.51. Median weight for patients with intestinal atresia and meconium ileus was 2 Kg 1.3-3 kg. Median weight was 2.5 kg for malrotation and Meckelrsquos diverticulum and for Hirschsprung disease HDnbsp it was 2.5 kg 1.6-2.9 kg.Babies with atresia and meconium ileus presented earlier compared to those with HD and other conditions with obstruction presented late. Median age of presentation for intestinal atresia malrotation and HD was 2 days 10 days and 18 days respectively. Median age of presentation for Meckelrsquos diverticulum was 16 days. Most atresia patients 25 89.3 were premature as compared to only four premature patients in other group 31 12.5.Bilious vomiting abdominal distention and failure to pass meconium or stool were the most prominent features of presentation in most cases. Septicaemia 53.3 was most common complication followed by wound infection 16.6 pneumonitis 8.3 and anastomotic leak 5. 1 case of jejunal atresia and 2 cases of ileal atresia were reexplored due to anastomotic leak.12 20 cases had mortality due to septicaemia and prematurity.nbspConclusionnbspIntestinal atresia was most common cause of neonatal intestinal obstruction in our study and septicaemia was most common cause of morbidity and mortality. Early diagnosis including prenatal diagnosis and planned delivery in a fully equipped pediatric surgical centre is recommended for better outcome.