Intestinal Obstruction In Infants Research Articles

Segmental absence of intestinal musculature: A rare cause of intestinal obstruction in infants

Segmental absence of intestinal musculature (SAIM) is a rare entity of unknown cause. Presenting features vary from intestinal obstruction, necrotizing enterocolitis, volvulus, and intussusception to spontaneous intestinal perforations. In majority of the cases, SAIM is a histological diagnosis. Here, we present a case of a 1-month female baby who presented with fever, abdominal distension, and vomiting. Resected segment of intestine histologically showed focal segmental absence of the muscularis propria. To the best of our knowledge, fewer than 50 cases of SAIM have been reported in the literature so far.

Presentation and management outcome of children with intussusception at Tenwek Hospital, Kenya

Background: Intussusception, a common cause of Intestinal obstruction in infants and young children, occurs when one segment of the bowel invaginates into a distal segment. While non-operative reduction has been well described, surgery remains the predominant mode of therapy in many developing countries due to delayed presentation. This study aimed to describe the presentation, management and outcome of children with intussusception at a single institution.Method: A retrospective review of patients aged 16 years and below with intussusception managed at Tenwek hospital from January 2009 through December 2014 was undertaken. Diagnosis was based on the presenting signs, symptoms, physical findings and plain upright or supine abdominal X-rays, and confirmed via ultrasonography, barium enema or at surgery.Results: A total of 45 cases (24 boys, 21 girls) of intussusception were noted, with a mean age of 2.6 years (range 1 month-15 years). The mean duration between symptom onset and presentation was 4.4 days (range 1-14), and the classic triad (vomiting, bloody mucoid stools and abdominal pain/distension) was noted in 27 (60%) cases. Abdominal ultrasound was diagnostic in 7 of the 11 cases ordered, with the rest diagnosed clinically. Non-operative reduction was undertaken in 4 cases and successful in 3. Surgery was performed in 42 cases with bowel gangrene and perforation noted in 20 (47.6%) and 15 (35.7%) cases respectively. The main types of intussusception were ileocolic (23, 51.1%), colocolonic (10, 22.2%) and ileoceacal (7, 15.6%). Five (11.1%) mortalities and 4 (8.8%) morbidities were noted at discharge, most commonly being surgical site infection in three cases.Conclusion: Intussusception, in this series, was primarily diagnosed clinically and managed surgically, with a majority of the patients having gangrenous or perforated bowel at laparotomy.Keywords: Intussusception, children, management, outcome, Kenya

Case series of unusual causes intestinal obstruction in infants and children

Introduction Many of the causes of intestinal obstruction arise from congenital anomalies that can present at any time from infancy to adulthood. Other frequent causes of intestinal obstruction in pediatric population results from complicated external hernias, intussusceptions, volvulus, or bands of adhesions. Patients and methods We report seven unusual cases presented with symptoms and signs of acute intestinal obstruction in infants and children, which necessitated surgical intervention. Radiological investigation showed signs of intestinal obstruction. Results On exploration, rare causes of intestinal obstruction were found. In the first patient, congenital mesenteric defect was the cause of obstruction. The second patient had unusual entrapment of a loop of bowel in the ileocecal recess. In the third patient, non-Hodgkin’s lymphoma was the leading point for intussesception. In the fourth patient, a large multiloculated chylolymphatic cyst was found. In the fifth, sixth, and seventh patients, a rare presentation of remnants of ophalomesentric duct was identified. In the eighth patient, a large polyp of Peutz–Jeghers syndrome was found to obstruct the lumen of the jejunum, and it was the nidus for jejunojejunal intussesception. All of the previously mentioned causes of obstruction are rarely observed in children. Conclusion Management of these conditions requires ahigh degree of suspicion, careful assessment, and awareness while the appropriate treatment needs to be tailored to the individual situation. Keywords : childhood period, intestinal obstruction, unusual presentations

Pediatric Intussusception in Northern Iran: Comparison of Recurrent With Non-Recurrent Cases.

Background:Intussusception represents as the invagination of a part of the intestine into itself and is the most common cause of intestinal obstruction in infants and children between 6 months to 3-years-old. Objectives:The objective of this study was to determine the recurrence rate and predisposing factors of recurrent intussusception.Patients and Methods:The medical records of children aged less than 13-years-old with confirmed intussusception who underwent reduction at a tertiary academic care in northern Iran (Mazandran), from 2001 to 2013 were reviewed. Data were extracted and recurrence rate was determined. The two groups were compared by chi square, Fisher, Mann-Whitney and t-test. Diagnosed cases of intussusception consisted of 237 children. Results:Average age of the patients was 19.57 ± 19.43 months with a peak of 3 to 30 months. Male to female ratio was 1.65 and this increased by aging. Recurrence rate was 16% (38 cases). 87 (36.7%) underwent surgery. These were mainly children under one year old. In 71% (40) of episodes recurrence occurred 1 to 7 times within 6 months. The recurrence occurred in 29 (23.5%) children in whom a first reduction was achieved with barium enema (BE) and 5 (5.7%) children who had an operative reduction (P < 0.001) in the first episode. Pathological leading points (PLPs) were observed in 5 cases; 2.6% in recurrence group versus 2% in non-recurrence group (P = 0.91). Three patients had intestinal polyp, 2 patient’s lymphoma and Mackle’s diverticulum. Age (P = 0.77) and sex (P = 0.38) showed no difference between the two groups. PLPs were observed in 1.4% of children aged 3 months to 5 years. This was 13.3%, in older children (P = 0.02).Conclusions:The recurrence of intussusception was related to the method of treatment in the first episode and it was 5-fold higher in children with BE than in operative reduction. Recurrent intussusceptions were not associated with PLPs, they were more idiopathic.

Clinical study and management of intestinal obstruction in infants

Background: Intestinal obstruction is a common surgical emergency in infants. There is a regional variation in the etiology of this condition. This study was conducted to determine the aetiology, clinical presentation of intestinal obstruction in infants, and outcome of surgical management. Methods: This prospective descriptive study was conducted in department of surgery at a tertiary care teaching hospital at Solapur, Maharashtra, India from January 2011 to December 2013. All the patients, irrespective of sex with diagnosis of intestinal obstruction undergoing surgical intervention were included in the study. Surgical findings were recorded and in the postoperative period patients were followed up for detection of complications and their treatment. Results: 50 patients were treated for intestinal obstruction with male to female ratio of 1.9:1. Majority of them (76%) presented within 1 month after birth. Abdominal distension and vomiting were the prominent symptoms of presentation. Wound infection was the commonest postoperative complication. Conclusions: Anorectal malformation was the most frequent cause of intestinal obstruction in our patients followed by intestinal atresia. Septicaemia was the commonest cause of death in post-operative period. Associated congenital anomalies increased the morbidity and mortality.

Pattern of Intussusception on Infants and Children in Dr. Hasan Sadikin Hospital Bandung

Background : Intussusception is the most frequent cause of acute intestinal obstruction in infants and toddlers. Incidence was reported at 1.5 to 4 cases for every 1000 live birth. In Dr. Hasan Sadikin General Hospital, Bandung, 55 cases were reported between 2005–2008. This study aimed to identify the characteristics of intussusception patients at Department of Pediatric Surgery Dr. Hasan Sadikin General Hospital, Bandung periode 2009–2011. Methods : This was a retrospective descriptive study by using medical records of intussusceptions patient’s from January 2009 to December 2011. The information collected were age, gender, chief complaint, signs and symptoms, onset of symptoms, nutritional status, history of previous infection, type of intussusceptions, pathologic lead point, and complications; including bowel necrosis and sepsis. The collected data was analyzed and presented as percentages shown in tables Results: There were 32 cases found, of which 84.4% affected well-nourished infants <1 year. Male was predominant (2:1). Bloody mucous stool was the major chief complaint (84.4%). Accompanying symptoms were pain due to colic, vomiting, bloating, and abdominal mass. Eleven patients were found with the onset of symptoms at ≤24 hours. Thirty-one percent (31%) cases were reported with the history of respiratory tract infection and 44% cases with the history of diarrhea. Most common type found was ileocolic. Pathologic lead point was only found in a single case. Conclusions : Intussusception cases in Dr. Hasan Sadikin General Hospital are decreasing, with the characteristics mainly affect well-nourished children, under 1 year old, predominantly male. The prominent chief complaint is bloody mucous stool, whereas ileocolic is the most common type with history of infection. [ AMJ .2015;2(3):458–62] DOI : 10.15850/amj.v2n3.502

A Rare Cause of Intestinal Obstruction in Infants: Ileum Duplication Cyst and Literature Review.

Cases of neonatal gastrointestinal system (GIS) obstruction are quite complex for pediatric surgery clinics. A rare cause of intestinal obstruction is the duplication cyst (DC). A three-day-old male patient presented at our clinic with a history of abdominal distension and bilious vomiting on the second day following birth. Although pathology had not yet been determined from observation and examination, surgery was performed when the patient could not tolerate oral feeding. An ileal DC forming an incomplete obstruction was observed. Ileoileal anastomosis was performed on the patient. Because DCs can present with different clinical symptoms, it is quite difficult to diagnose them in neonate patients. Lacking an imaging method that can provide an exact diagnosis, the diagnostic laparotomy is a suitable approach for both diagnosis and treatment to avoid delays in treatment.

Intussusception Incidence Rates in 9 Zambian Hospitals, 2007–2011

Intussusception, a rare adverse event associated with rotavirus vaccines in some settings, is a common cause of intestinal obstruction in infants and toddlers globally with a peak age of 4-6 months. This age group may overlap with the extended age of administering rotavirus vaccine. A retrospective (January 2007 to June 2009) and prospective (July 2009 to June 2012) survey was conducted in 9 Zambian hospitals. Children between 0 and 24 months who were operated on for intestinal obstruction/intussusception were identified in theatre log books. In the latter part of the survey, patients were recruited prospectively. Demographic, clinical and surgical data from hospital files were collected for each patient. One-hundred and five children were identified to have undergone surgery for intussusceptions. Many were boys 57.6% (57/99). Of those with complete data, intussusception was common in infants 86.9% (86/99) and many children (68.0%) were between 3 and 8 months of age with a peak age of 5-6 months. Lusaka had the highest number of children with intussusception with an estimated annual incidence rate of 12/100,000 in children <2 years of age. The overall case fatality rate was very high 33.7% (31/92). Intussusception was common in infants with a peak age of 5-6 months, and of particular concern is the group of 2-4 months the age of rotavirus vaccination. The estimated incidence rate of 12/100,000 is an underestimate as many cases may not present for care. The high case fatality rate of 33.7% is due to both delayed presentation and diagnosis in hospital.

Developmental changes of internal anal sphincter in guinea pigs

Introduction The internal anal sphincter (IAS) plays an important role in the maintenance of anorectal continence and in the pathophysiology of constipation and incontinence. Failure of a full-term newborn to pass meconium within the first 24 h should raise a suspicion of intestinal obstruction. However, the causes of functional intestinal obstruction in infants are still unclear; however, one cause might be immaturity of the IAS. Aim of the work This study aimed at illustrating the developmental changes in IAS in guinea pigs of different ages. Materials and methods Forty-one guinea pigs were selected and divided into four groups. They were sacrificed and the rectoanal canal specimens were dissected at the appropriate time from each group as follows: group I – from embryos in the third trimester; group II – from animals on their first postnatal day; group III – from animals aged 4 weeks; and group IV – from animals aged 16 weeks. The rectoanal canal specimens was prepared for histological and immunohistochemical studies. Morphometric analysis was also performed. Results Thickness of the IAS increased with advancing age, whereas that of the connective tissue component decreased. Moreover, α-smooth muscle actin filaments increased with age. There was also age-related development of the enteric nervous system, especially the myenteric plexus in the rectoanal junction region. Conclusions Results of the current study revealed pronounced developmental changes in the histological structure of guinea pig IAS. Therefore, development of the IAS might have a possible role in the functional intestinal obstruction seen in preterm and full-term infants.

Superior Mesenteric Artery Syndrome : A Rare Cause of Upper Intestinal Obstruction in Infants

Superior Mesenteric Artery Syndrome : A Rare Cause of Upper Intestinal Obstruction in Infants

English

Intussusception is the most common cause of acute intestinal obstruction in infants. Intussusception affects predominantly children in the 1 st and 2 nd years of life. We present here our experience with four patients of intussusception presenting in early infancy in early summer months.

Ability of Pediatric Physicians to Judge the Likelihood of Intussusception

Intussusception is the most common cause of intestinal obstruction in infants and children. To date, no study has evaluated the ability of physicians to predict the likelihood of intussusception. This study aimed to determine the ability of pediatric physicians to predict intussusception in patients being evaluated for intussusception and to investigate whether certain clinical findings correlate with physicians' risk assessment. A prospective cohort study of children aged 1 month to 6 years who presented with possible intussusception. The predicted likelihood of intussusception was recorded by physicians before knowledge of imaging results or final diagnosis. We defined a physician's prediction as high versus low risk based on a threshold prediction of 25% likelihood. A total of 308 patients were studied including 38 (12.3%) with intussusception. Physicians' prediction was positively associated with the risk of intussusception (test for linear trend: odds ratio [OR], 2.1; 95% confidence interval [CI], 1.6-2.7; P < 0.001). Among patients considered high risk, the rate of intussusception was 36% (95% CI, 25%-49%) compared with 6% for those judged to be low risk (95% CI, 4%-10%). Using a threshold of 25% likelihood, successful prediction of high versus low risk occurred in 82% (95% CI, 77%-86%). Clinical predictors associated with assigning a designation of higher risk of intussusception included lethargy at home (OR, 2.7; 95% CI, 1.4-5.5) and bloody stool (OR, 2.5; 95% CI, 1.0-5.9). Pediatric physicians can accurately predict the likelihood of intussusception. This ability to properly judge the risk of intussusception can be incorporated into management strategies.

Prospective surveillance study of the management of intussusception in UK and Irish infants

Intussusception is the most common cause of acute intestinal obstruction in infants. This study examined the clinical presentation, management and outcomes of intussusception in this age group. Prospective surveillance of intussusception in infants was carried out between March 2008 and March 2009 in the UK and Ireland. Monthly cards were sent to paediatric clinicians who were requested to notify cases of intussusception. The study identified 261 confirmed cases. The commonest presenting symptom/sign was non-bilious vomiting, in 210 (80·5 per cent) of the infants. Abdominal ultrasonography was done in 247 infants (94·6 per cent) and was diagnostic in 242 (98·0 per cent), compared with plain abdominal X-ray, which was diagnostic in 33 (23·6 per cent) of 140 infants. Enema reduction was carried out in 240 (92·0 per cent) of the 261 infants; the majority (237, 98·8 per cent) had pneumatic reduction with a success rate of 61·2 per cent (145 of 237). Surgery was required in 111 infants (42·5 per cent); 92 operations were as a result of unsuccessful enema reduction, and the remaining 19 infants (17·1 per cent) had primary surgery. Forty-four infants (39·6 per cent of operations) needed a bowel resection. The majority of children (238, 91·2 per cent) recovered uneventfully; 21 (8·0 per cent) had sequelae, one child died (0·4 per cent), and the outcome was unknown for one infant. This study described current treatment patterns for intussusception in infancy; these represent a benchmark for improved standards of care for this condition.

Adhesive Intestinal Obstruction in Infants and Children: The Place of Conservative Treatment

Objectives. Adhesive intestinal obstruction (AIO) is rare in the pediatric age group and its treatment is still controversial. This is a retrospective review of our experience in infants and children with AIO. Patients and Methods. The records of infants and children with AIO between January 2001 and December 2010 were retrospectively reviewed for age at diagnosis, sex, initial operation, interval between initial operation and presentation, diagnosis, treatment and outcome. Results. 44 infants and children were admitted with AIO. There were 28 males and 16 females who had 46 episodes. Their ages at presentation ranged from 1 month to 12 years (mean 5.4 years), while their ages at initial operation ranged from 2 days to 12 years (mean 4.15 years). Time elapsed from initial operation to presentation ranged from 7 days to 8 years (mean 1.5 years), and 66% developed AIO within 1 year from initial operation. Appenedecectomy was the commonest operation (29.5%). Four (9%) responded to conservative treatment. The other 40 (91%) required surgical intervention. Twenty-nine had release of adhesions only, while 10 (25%) had resection of small intestines and one underwent stricturoplasty. Two developed recurrence and one died. Conclusions. AIO is rare in the pediatric age group and the majority becomes symptomatic within 1 year of operation. Appendecectomy is the commonest operation leading to AIO. The place of conservative treatment is limited and to obviate delay and decrease the chance of intestinal ischemia, they should be treated early with surgical adhesiolysis.

Pediatric intussusception: A Case Series and Literature Review

Background: Intussusception is the major cause of acute intestinal obstruction in infants. The classic clinical triad of intussusception is colicky abdominal pain, vomiting and bloody stools. However, only 20% of patients present with this triad. Objectives: The objective of this article with a series of cases of intussusception is to review the spectrum of clinical presentation of this disease entity. Methods and Results: We describe 3 patients with intussusception that presented to our Emergency Department (ED) with different complaints. Also this article reviews diagnosis and management strategies of intussusception. Conclusions: Clinical suspicion is the key for diagnosis. This article highlights the importance of suspecting intussusception by the ED physician in any child with abdominal pain, gastrointestinal symptoms or altered mental status.

Postnatal changes in enteric plexus axonal thickness

Chronological age has not always been an accurate predictor of gut motility in newborns. We hypothesized that the enteric plexus is immature at birth. We studied whole-mount preparations of the myenteric plexus in pigs from mid-point of gestation to adulthood. Distal large bowel whole-mount preparations of the myenteric plexus were stained using ACHE histochemistry in five pigs from six different age groups (60 and 90 days gestation, newborn, 4 and 12 weeks old, and adult pigs). With the aid of light micrographs and Image J program the axonal diameter, distance between ganglia, neuronal size and neuronal nucleus size were measured. Statistical significance was measured using one-way ANOVA test. There was significant increase in axonal diameter and interganglionic distance, with increasing age in the myenteric plexus of rectum in pigs (P < 0.05). Neuronal cell size and nucleus size of the enteric neurons also increased with age, but was not statistically significant. This study shows for the first time that the axonal thickness in the enteric myenteric plexus undergoes striking changes during the first 12 weeks of life in piglets. Assessment of axonal thickness in rectal biopsies may be a valuable morphological feature in diagnosing functional intestinal obstruction in infants.

Childhood intussusception in north eastern Nigeria: a review of its surgical management

Background: Intussusception is the commonest cause of intestinal obstruction in the 3 months to 2 years age group. Adequate awareness of its presenting features is important for an early diagnosis and treatment. Aim: To present an experience of its surgical management in Nigerian infants and children. Setting: The University of Maiduguri Teaching Hospital. Methods: A retrospective study of patients with intussusception seen and treated between January 1999 and December 2002 was done. Their case files were studied for age, sex, presentation, definitive treatment and outcome of treatment. These were analyzed using tables. Results: Thirty-seven infants and children were seen during the study period. There were 24 males (64.8%) and 13 females (35.1%). The male to female ratio was 1.8:1. The mean age was 14.7 ± 22.61 months (range 2 months - 8 years). Twenty-two (59.4%) of the patients were aged between 3 and 9 months and 25 (67.5%) were below one year. The commonest presenting symptoms were abdominal pain (86.4%), vomiting (75.6%) and palpable abdominal mass (54.0%). Twenty-one patients (56.7%) presented to hospital latter than 72 hours from the onset of symptoms. At laparotomy, the commonest type of intussusception was ileocolic (48.6%). Twenty-three (62.1%) patients had simple manual reduction while 14 (37.8%) had bowel resection and anastomoses. There was no recurrence of intussusception after a mean follow-up of 27.8 ± 29.5 weeks. The mortality rate was 16.2%. Conclusion: Intussusception is a common cause of intestinal obstruction in infants and children in this environment. Late presentation is common and accounts for the high mortality. Outcome of treatment can be improved with high index of suspicion Keywords: Intussusception, Infants, Childhood, Surgical and non-surgical reductionPort Harcourt Medical Journal Vol. 3 (1) 2008: pp. 27-31

Paediatric intussusception.

Intussusception is one of the commonest causes of intestinal obstruction in infants and accounts for about 700 hospital admissions each year in England and Wales. Improved results of treatment have followed recent technological developments, which include ultrasonographic imaging and pneumatic reduction techniques. Most intussusceptions can be reduced successfully without the need for operation but close cooperation between surgeon and radiologist is essential. Mortality and morbidity rates from the condition have progressively declined in recent decades but avoidable deaths still occur.

Intestinal obstruction in infants and children

Infants and young children who arrive in the emergency department with intestinal obstruction can usually be recognized by history alone or by sorting through the presenting signs and symptoms. Intestinal obstruction will present with 1 or more of the typical triad; colicky abdominal pain, vomiting, and/or abdominal distension. Because surgical intervention may be required emergently, delays in diagnosis must be avoided. This report covers surgically correctable intestinal obstructions in infants and children that are commonly encountered or require an astute clinician skilled to make a timely diagnosis.

Meconium diseases in infants with very low birth weight.

Retained meconium resulting in intestinal obstruction in infants with very low birth weight (VLBW) may cause significant morbidity and even mortality. Immature intestinal neuromuscular function, abnormal meconium composition, and maternal magnesium sulfate therapy results in delay of first meconium passage. This "normal" passage of first meconium may not occur until 1 week of life or later. A spectrum of conditions results from this delayed passage. At the most serious end of this continuum is intestinal obstruction. These patients present with abdominal distension, emesis, and reduced stool frequency. Early diagnosis of this condition using plain abdominal radiographs and contrast enemas where appropriate is imperative. Contrast enemas may be both diagnostic and therapeutic. Most patients do not need surgical intervention. Operation is indicated when enemas fail to relieve the obstruction or perforation occurs. Prompt diagnosis and appropriate management results in a good outcome. Meconium obstruction in VLBW infants does not appear to be associated with cystic fibrosis or Hirschsprung's disease.