Cause Of Neonatal Bowel Obstruction Research Articles

A rare cause of neonatal feeding intolerance: congenital segmental intestinal dilatation—a case report

BackgroundCongenital segmental intestinal dilatation (CSID) is a rare cause of neonatal bowel obstruction. Patients can present in the early newborn period with feeding intolerance and abdominal distension. Diagnosis is challenging due to its rarity and non-specific clinical and radiological findings in a well neonate. Surgical excision remains the mainstay treatment for this disease.Case presentationWe report a case of a newborn male with congenital segmental ileal dilatation, who presented with abdominal distension and feeding intolerance. He was born preterm at 32 weeks and was treated for presumed sepsis due to a premature rupture of the membrane. The patient developed persistent abdominal distension upon initiation of feedings with large amount of gastric aspirates. Otherwise, there was no delay in the passage of meconium. Serial abdominal radiographs showed persistent focal bowel dilatation on the right side. He was initially diagnosed with small bowel atresia. Ultrasound abdomen and lower gastrointestinal contrasted study showed focal ileal dilatation with no evidence of pneumoperitoneum. Intraoperative findings revealed a segmental ileal dilatation with no evidence of mechanical obstruction. The abnormal dilated bowel was excised and sent for histopathological examination. He recovered well after surgery.ConclusionDiagnosis of CSID can be challenging due to its clinical polymorphism and non-specific radiological findings. CSID should be suspected in neonates with feeding intolerance and focal intestinal dilatation without clinical features of sepsis, peritonitis, or mechanical obstruction. Surgical excision is curative with a good outcome.

Jejunal adenomyoma in a neonate, an extremely rare cause of neonatal bowel obstruction

We report a case of jejunal adenomyoma in a neonate, found during exploratory surgery for bilious vomiting and feeding intolerance. This is the first reported case of neonatal jejunal adenomyoma as an isolated cause of intestinal obstruction.

Intestinal malrotation with multiple congenital anomalies

Intestinal malrotation (IM) occurs secondary to abnormal midgut rotations. It is a common and often devastating cause of neonatal bowel obstruction. Associated anomalies in IM is high, up to 60%. We present a case malrotation without volvulus in a day 8 of life neonate associated with duodenal atresia (fenestrate web), annular pancreas, polysplenia, preduodenal portal vein and anorectal malformation (rectoperineal fistula). This case offered a unique presentation of malrotation with multiple anomalies, and highlights need of high index of suspicion of additional congenital anomalies when managing malrotation.

Outcome of Tapering Enteroplasty in Managing Jejunoileal Atresia.

Jejunoileal atresia (JIA) represents a common cause of neonatal bowel obstruction. There is a discrepancy between the diameters of the proximal and the distal bowel loops and this is managed with excision or tapering of the dilated proximal bowel loop. We aim primarily to evaluate the outcome of tapering enteroplasty (TE) in managing JIA and secondarily to compare the outcome of TE to non-TE. A retrospective analysis of records of all neonatal admissions with JIA from January 2017 to December 2018 at a tertiary university children's hospital. Type and location of atresia, time to full enteral feeds, length of stay (LOS), complications, and outcome were assessed in TE and non-TE groups. Forty-one patients were included in the study; 29 (70.7%) cases had jejunal atresia and 12 (29.3%) had ileal atresia. Seventeen (41.4%) patients had TE. The median days to full feeds was 19; 28 in the TE group versus 16 in the non-TE group (P = 0.022). Four (9.7%) cases needed a re-exploration because of failure to start feeds; all in the non-TE group. The median LOS was 33 days for TE versus 22 days for non-TE (P = 0.101). Twenty-one cases (51.2%) developed a wound infection and showed a significantly longer median LOS of 29.5 versus 19 days (P = 0.019). Mortality was 7 (17.1%). TE did not show a superior outcome when compared to resection of the dilated bowel. It was associated with longer time to reach full enteral nutrition and longer LOS.

Intestinal duplication cyst: a rare cause of neonatal bowel obstruction

Intestinal duplication cyst: a rare cause of neonatal bowel obstruction

Milk curd obstruction: An increasingly common rarity?

Introduction: Milk curd obstruction is a rare, yet important cause of neonatal bowel obstruction that has been seldom reported in the literature. The presentation has evolved over time: Initially being seen in formula-fed term babies, to now being more prevalent in premature babies that require milk fortification. We present a case series of four patients treated for the condition at our institution and report that there may be additional contributing factors that have not been previously described. Method: Case notes of four patients that were diagnosed with milk curd obstruction over a one-year period were retrospectively analysed. Data collected included: gender, gestational age at birth, birth weight, pre-existing gastro-intestinal pathology, previous surgeries, feeding regimens used as well as the management and outcomes of milk curd obstruction. Results: All patients included in the series were premature, with three being classified as extremely low birth weight (ELBW). All babies received fortified expressed breast milk feeds. Three patients were treated for necrotising enterocolitis (NEC) prior to being diagnosed with milk curd obstruction. Two patients had undergone surgery for abdominal pathology ahead of their diagnosis. Three of the four babies required operative management for milk curd obstruction, whilst one was successfully managed conservatively. There were no mortalities. Conclusion: Previous gastrointestinal pathology as well as previous surgery may be associated with the development of milk curd obstruction. Milk curd obstruction is becoming an increasingly significant cause of neonatal bowel obstruction and further research and investigation is required to establish patterns of causation.

Meckel�s diverticulum causing intestinal obstruction in the newborn

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.

Neanatal Intestinal Obstruction

Background: Intestinal obstructions are the most common surgical emergencies in the neonatal period. Neonatal intestinal obstruction occurring during the first month of life. Early and accurate diagnosis of intestinal obstruction is important for proper patient management. This presentation is a brief review of studies in Pubmed and Google scholar. For evaluation and diagnosis, intestinal obstruction in neonates can be divided into either high or low obstruction on the basis of dilated bowel loops present on abdominal radiographs. A few dilated bowel loops are seen with high intestinal obstruction and several bowel loops are generally seen with low intestinal obstruction. High intestinal obstructions are defined as occurring proximal to the ileum with differential diagnosis and radiographic appearance as below: 1) Gastric atresia: in microgastria a distended esophagus and a small midline stomach and In gastric atresia single bubble with no distal gas. 2) Duodenal atresia: double bubble sign 3) Malrotation with Ladd bands and midgut volvulus can be partial or complete obstruction: the abdominal radiograph in malrotation is nonspecific. It may be normal or may show a proximal bowel obstruction pattern, or show dilatation of multiple bowel loops. 4) Duodenal web partial obstruction with small amount of distal bowel gas. 5) Annular pancreas. 6) Preduodenal portal vein. 7) Jejunal atresia: triple-bubble sign with no gas in the distal bowel. Dilatation of the duodenum is a sign of chronic obstruction, therefore seen in duodenal atresia, duodenal web and annular pancreas. When obstruction occurs acutely after birth in midgut volvulus, the duodenum is not usually dilated on plain film. In complete obstruction in the high jejunum, no further roentgenographic studies are required, however, in partial obstruction (small amount of distal gas) upper GI study may be helpful to distinguish between duodenal web and malrotation with Ladd bands or midgut volvulus. The classic upper gastrointestinal appearance of malrotation with volvulus consists of an abnormal course of the duodenum that fails to cross the midline combined with a corkscrew appearance. In contrast, low intestinal obstructions involve the distal ileum or colon and typically result in diffuse dilatation of multiple small-bowel loops. If distal small bowel obstruction is suggested, a contrast enema usually is necessary. It is not possible to differentiate distal small bowel from colonic obstruction on the basis of plain abdominal roentgenograms, and consequently, contrast enema is necessary to clarify microcolon in ileal atresia and meconium ileus and differentioation from other pathology as below: 1) Meconium ileus: unused colon (i.e., microcolon), within which are multiple small filling defects representing meconium concretions. If there is reflux of contrast material beyond the ileocecal valve, multiple small filling defects (meconium concretions) also may be seen in the terminal ileum. 2) Ileal atresia: Microcolon and blind ending ileum on contrast enema. 3) Meconium plug and small left colon syndrome: multiple filling defects (i.e., meconium plugs) is seen in splenic flexure with left sided microcolon and with normal rectum. 4) Hirschsprung disease: abnormal rectosigmoid ratio (< 1), transition zone of rectal narrowing, irregular rectal contraction and retained contrast material on delayed radiographs, 5) Colonic atresia: contrast enema study typically shows a distal unused colon (i.e., microcolon), with the more proximal markedly dilated colon ending in a blind pouch.6) Anorectal malformation. In any of these cases, if intestinal perforation occurs meconium peritonitis can result and peritoneal calcifications can be seen on plain films. Conclusions: Intestinal obstructions are the most common surgical emergencies in newborn infants which require early and accurate diagnosis. An understanding of the characteristic imaging appearance of various causes of neonatal bowel obstruction on abdominal X-ray can lead to correct diagnosis or leading a guide to the next appropriate step. After abdominal X-ray that shows the presence of a neonatal high intestinal obstruction, an upper gastrointestinal series is typically performed for further evaluation. However, neonates with classic radiographic findings of high intestinal obstruction, such as duodenal atresia, may undergo surgery without any additional imaging study. An enema examination is used for further investigation of low intestinal obstruction in neonates.

Established and emerging concepts in Hirschsprung's-associated enterocolitis.

Hirschsprung's disease (HSCR) is a common cause of neonatal bowel obstruction and the approach to diagnosis and surgical treatment is well defined and accepted. Hirschsprung's-associated enterocolitis (HAEC) remains a frequent cause of pre-operative and post-operative morbidity and mortality, with unchanged treatment guidelines over multiple decades. Recent advances in our understanding of the genetics underlying HSCR have allowed the development of animal models, some of which recapitulate the HAEC phenotype. These animal models, along with recent translational studies, have implicated multiple facets of mucosal immunity and microbiome dysbiosis in the development of HAEC. Here, we will review the established epidemiology, modes of diagnosis and treatment of HAEC. Furthermore, we will explore emerging concepts in the pathogenesis of this disease; including animal models, alterations in mucosal immunity, dysbiosis of the intestinal microbiome, specific genetic susceptibility, and novel treatment modalities.

Congenital Colonic Atresia: 4 Case Reports

Introduction: Colonic atresia is a rare cause of neonatal bowel obstruction. Choosing between intestinal diversion and primary anastomosis for the management of this atresia is still discussed. Methods and results: We reviewed all cases of colonic atresia managed in our center between 2000 and 2012. We have recorded, summarized and analyzed clinical features, associated anomalies, location and type of atresia, management and outcome. We collected four cases of colonic atresia handled in our department during this period, one case of type I and three cases of type III according to the Grosfeld classification. Three of the cases had at least one-associated anomaly. Initial restoration of bowel continuity with a protective diversion was performed in one case, Delayed anastomosis following a primary intestinal diversion was performed in two cases, and primary anastomosis was performed in a one case. Death occurred in one case following a post-operative sepsis. Conclusion: Atresia of the colon is a rare etiology of the neonatal bowel obstruction. Colonic atresia can be associated with other congenital anomalies, which affect the prognosis. The prognosis of Colonic atresia in absence of other serious associations is good if proper management is carried out, with an overall mortality of 10%.

Duodenal atresia with major duodenal papilla within duodenal atretic segment: A case report

Duodenal atresia is a common cause of neonatal bowel obstruction and presents with numerous anomalies. Ampullary anomalies are rare, but one must consider potential abnormalities to both the biliary ductal system and the ampulla of Vater to avoid injuries. This case presents a solitary biliary duct draining into an atretic duodenal segment. A persistent narrow communicating channel within the atretic segment prevented complete biliary obstruction. A sphincteroplasty in association with a standard duodenal atresia repair provided an excellent solution to an uncommon problem.

Involvement of down-regulated E2F3 in Hirschsprung's disease

Background/PurposeHirschsprung's disease (HSCR) is a common cause of neonatal bowel obstruction characterized by the absence of ganglion cells in the colon. Impaired migration of the neural crest cells (NCCs) has been implicated as one of the main causes of HSCR. E2F3, a member in the E2F family, which plays a crucial role in the control of the cell cycle is correlated with neuron migration. However, the function of E2F3 in the development of the enteric nervous system still remains unknown. This study aims to reveal the correlation of E2F3 in the progress of HSCR. MethodsBy using reverse transcriptase polymerase chain reaction (RT-PCR) and western blot assay, we investigated levels of E2F3 expression in 58 HSCR patients, both in the aganglionic bowel segment and the normal ganglionic segment, and in 39 unrelated controls. By in vitro assays, we used the siRNA method to knock-down the level of E2F3 expression in 293T cell lines. Furthermore, transwell assay was used to detect cell migration ability. ResultsAberrant lower expression level of E2F3 was detected in the HSCR-S segment compared with the control group by RT-PCR and western blot assay. Besides, down-regulated E2F3 could suppress the cell migration. ConclusionsThis is the first study showing the down-regulation of E2F3 in HSCR, bringing new insight to the mechanism of the impaired migration of neural crest cells.

Imaging findings in megacystis-microcolon-intestinal hypoperistalsis syndrome

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a rare and frequently lethal form of severe functional intestinal obstruction more commonly found in girls. Imaging features characteristic of this disease include a large dilated bladder, microcolon and intestinal dysmotility. Additional imaging findings may include intestinal malrotation, hydronephrosis and vesicoureteral reflux. It is usually fatal in the first year of life. Because presenting clinical and imaging features can mimic other causes of neonatal bowel obstruction, we compiled examples of this disorder to help the pediatric radiologist recognize imaging findings associated with MMIHS and aid in the development of a long-term management plan and in counseling the family regarding implications of this disorder. We reviewed recent and historical literature relevant to MMIHS and present the imaging and clinical features of four patients with MMIHS treated at our institution as examples of this uncommon disorder.

Repair of duodenal atresia under spinal anesthesia in a low-birth-weight preterm neonate: case report

Duodenal atresia is a well-recognized cause of neonatal bowel obstruction. General anesthesia with tracheal intubation is the traditional anesthetic technique for surgical correction of this condition. Metabolic abnormalities and fluid deficits coupled with residual anesthetics are known to increase the risk of postoperative apnea, prolonging the operating room time and delaying extubation. Spinal anesthesia (SA) is an accepted alternative to general anesthesia in formerly preterm infants. In the current literature, there are reports of successful use of SA for simple infraumbilical surgery and, occasionally, for upper abdominal surgery, but there is no information on the use of SA in neonates for duodenal atresia repair. We present a case of duodenal atresia in a preterm infant at a gestational age of 30 weeks with coexisting bronchopulmonary dysplasia successfully repaired under SA. Further studies that compare the adverse effects with the potential advantages of SA are warranted before future recommendations are made for neonates who are undergoing upper abdominal surgery.

Double duodenal atresia with perforation: a case report

Duodenal atresia is a common cause of neonatal bowel obstruction. Double duodenal atresia has been reported as a rare variation of duodenal atresia. This report discusses the importance of an appreciation of unusual anatomy in neonatal duodenal obstruction and highlights the importance of assessing bowel continuity intraoperatively.

Milk curd obstruction in premature infants receiving fortified expressed breast milk

Milk curd obstruction is one of the less common causes of neonatal bowel obstruction. It has been described in premature infants who received high caloric formula feeds. We report presentation, management and outcome of premature neonates who developed milk curd obstruction while being fed fortified expressed breast milk. A retrospective case note review of babies who were treated for milk curd obstruction in Royal Children's Hospital and Mater Children's Hospital in Brisbane between 2001 and 2007 was performed. Nine preterm neonates developed milk curd obstruction (mean gestational age 27 weeks). All babies received fortified expressed breast milk. Symptoms presented were those of bowel obstruction in the majority of cases. Laparotomy was required in eight babies, one had a pre-existing ileostomy that was washed out. Two babies died shortly after surgery, while two followed several months later. The diagnosis of milk curd obstruction should be considered in all premature babies with signs of bowel obstruction who are fed expressed breast milk with caloric fortification.

Understanding Neonatal Bowel Obstruction: Building Knowledge to Advance Practice

Providing care to neonates with bowel obstruction requires a basic understanding of gastrointestinal (GI) anatomy and functional landmarks as well as knowledge of the pathophysiology associated with intestinal blockage. Early recognition and prompt diagnosis necessitate astute assessment of common presenting symptoms and accurate interpretation of diagnostic investigations. Initial medical management is focused primarily on gastric decompression and maintenance of fluid and electrolyte balance. This article describes features of the neonatal GI tract and discusses common causes of neonatal bowel obstruction.

Le syndrome du « petit côlon gauche » (à propos de deux cas)

Case reports. – Two newborns, one female and male were treated for neonatal bowel obstruction. A contrast enema led to the diagnosis of small left colon syndrome and treated those newborns successfully. Conclusion. – Small left colon syndrome is a very rare cause of neonatal bowel obstruction. The diagnosis and treatment are assured by a simple contrast enema.