Neonatal Small Left Colon Syndrome Research Articles

A neonatal small left colon syndrome of nondiabetic mother

A neonatal small left colon syndrome of nondiabetic mother

Role of Radiologist in Diagnosis of Neonatal Small Left Colon Syndrome: A Case Report

Neonatal small left colon syndrome is a well-defined functional disease of the lower colon and it results in signs and symptoms of intestinal obstruction. It is an uncommon cause of neonatal intestinal obstruction characterised by an abrupt transition of intestinal caliber at or near the splenic flexure. More than 50% of affected patients are born to mothers with diabetes. We report a five-day-old neonate who presented with abdominal distension and vomiting diagnosed to have small left colon syndrome by contrast enema. He had surgical resection of the narrowed segment and anastomosis with subsequent resolution of symptoms.

Case 2: Abdominal Distention in a Term Infant with Unilateral Ventriculomegaly

An early term female neonate is born at 37 weeks, 2 days of gestation with a birthweight of 3.1 kg. She is delivered vaginally by a 26-year-old woman after induction of labor for preeclampsia with severe features; magnesium sulfate was given during labor. Prenatal history is significant for late prenatal care (14 weeks) and fetal diagnosis of right-sided ventriculomegaly noted on serial ultrasonography, first at 20 weeks of gestation and confirmed on fetal magnetic resonance imaging (MRI) at 27 weeks. All prenatal serologic findings were negative, a 1-hour oral glucose tolerance test result was within normal limits, and cell-free fetal DNA was negative for trisomies 13, 18, and 21. Maternal-fetal medicine, neonatal-perinatal medicine, and pediatric neurosurgical physician teams were involved in the prenatal care, and a plan was developed to admit the infant to the level III NICU after birth for further brain imaging.At delivery, the infant is vigorous, with Apgar scores of 9 and 9 at 1 and 5 minutes, respectively. Birthweight is at the 50th percentile, length is greater than the 97th percentile, and occipitofrontal circumference is at the 90th percentile. The remainder of the newborn examination is unremarkable, including a perforate anus, and the infant is admitted to the NICU for known right-sided ventriculomegaly. On the day of birth, postnatal MRI demonstrates asymmetric right-sided ventriculomegaly likely secondary to a prior germinal matrix and intraventricular hemorrhage. The infant feeds orally and voids normally but no stools are noted. At birth, a chromosomal microarray is obtained, which later reveals a likely benign duplication at 7q21.12-q21.13, with no known clinical significance associated.On the day after birth, the infant develops abdominal distention with decreased bowel sounds and lethargy. Oral feeding is discontinued and intravenous fluids are initiated. Vital signs are stable and examination findings are otherwise unremarkable, with no respiratory distress noted in room air. Voiding remains normal, but again, no stools are noted.A kidney, ureter, bladder (KUB) radiograph was obtained, which demonstrated mildly dilated loops of bowel throughout the abdomen. The infant was given nothing by mouth, and a Replogle tube was placed for abdominal decompression. Intravenous antibiotics (ampicillin and gentamicin) were started after performing a sepsis screen. The complete blood cell count and C-reactive protein levels were unremarkable. A repeat KUB radiograph remained concerning for a small bowel obstruction (Fig 1), and the infant developed bilious output from the appropriately positioned Replogle tube. A water-soluble contrast enema was performed on the third day, which revealed multiple intraluminal filling defects and meconium plugging (Fig 2). Shortly after the contrast enema, the infant began to pass stools, with 5 large-volume meconium stools noted in the following 24 hours. Abdominal distention and gastric output decreased, and a repeat KUB radiograph demonstrated decreased gaseous distention. Oral feedings were reinitiated 2 days after the enema and were advanced without difficulty. Daily occipitofrontal circumference measurements remained stable throughout the infant’s hospitalization. She was discharged from the hospital on the 7th day after birth, voiding and stooling appropriately, and with follow-up scheduled with the neurosurgical team to continue to monitor the stable ventriculomegaly.The differential diagnosis of abdominal distention in a newborn includes volvulus (with or without malrotation), necrotizing enterocolitis, sepsis, Hirschsprung disease, meconium syndromes (such as ileus or plug), intestinal webs or atresias, hypertrophic pyloric stenosis, congenital microcolon, spontaneous intestinal perforation, imperforate anus, peritoneal bands, internal hernias, and rarely, lactobezoars. (1)(2) Small left colon syndrome, first described in 1974, is thought to occur because of immaturity of the myenteric plexus ganglia (1) of the colon, which leads to a transient functional obstruction in newborns and carries a strong association with maternal diabetes mellitus, (3)(4) maternal preeclampsia treated with magnesium sulfate, (1) and prematurity. (1) Maternal diabetes mellitus, either gestational or pregestational, is the most common association, reported in 40% to 50% of the few published cases of small left colon syndrome. (3) Small left colon syndrome is the most common diagnosis in newborns who fail to pass meconium within the first 48 hours after birth. (1)(3)(4)(5)(6)Abdominal radiography will demonstrate lower bowel obstruction with or without air-fluid levels. Water-soluble contrast enema is frequently both diagnostic and therapeutic in these patients, demonstrating a significant change in colonic caliber. An abrupt transition occurs at the splenic flexure to a narrow distal colon, relieving the obstruction by flushing away any meconium present in the distal colon. Normal intestinal motility without long-term complications is expected in cases of neonatal small left colon syndrome.

Neonatal small left colon syndrome - Radiological diagnosis by gastrografin contrast study

Neonatal small left colon syndrome (NSLCS) is one of the suspected diagnoses if the neonate does not pass meconium within 24 h of birth. Radiological contrast studies play a vital role in diagnosing and treating the entity. We report a case where the newborn did not pass meconium till 4 days of birth and which on gastrografin studies was diagnosed as a case of NSLCS.

Small left colon syndrome in 3 sisters

Neonatal small left colon syndrome is a rare cause of bowel obstruction. Its etiology remains unknown, but a significant association has been noted between maternal diabetes and small left colon. No reported cases within the same family could be found in the literature, excepting 2 sets of twins. We report 3 cases of small left colon syndrome in 3 consecutive sisters born of a nondiabetic mother. This raises the question of a genetic factor in its etiology.

Neonatal small left colon syndrome in the offspring of diabetic mothers—an analysis of 105 children

Background and Aim Neonatal small left colon syndrome (NSLCS) is considered a rare cause of neonatal intestinal obstruction, with few documented cases in the English literature. Maternal diabetes has been reported in 40% to 50% of the published cases of NSLCS. Currently, the incidence of maternal diabetes is increasing, but there has been no study to ascertain the incidence and significance of NSLCS in this population. This review aims to assess the current significance of NSLCS and its association with maternal diabetes. Materials and Method This was a retrospective review of 105 offspring of diabetic mothers who were admitted during the period 2004 to 2008 to our neonatal unit with special emphasis on associated NSLCS. Results There were 6 cases of intestinal obstruction in this group of 105 children. Five children, including a pair of twins, had classic features of NSLCS as demonstrated in the contrast enema with an abrupt transition at the splenic flexure and a narrow left colon. Conservative treatment was successful in all, negating the need for further invasive investigation. The sixth child had rectosigmoid Hirschprung disease. During the study period, there were no other cases of NSLCS in the nondiabetic population. Conclusion Neonatal small left colon syndrome is the most common cause of intestinal obstruction in offspring of diabetic mothers. Neonatal small left colon syndrome can be confidently diagnosed in this population based on the classic clinical and radiologic findings. The incidence of NSLCS can be expected to increase as the incidence of maternal diabetes increases.

Intestinal obstruction in neonatal/pediatric surgery

Intestinal obstruction in the newborn infant and older child may be due to a variety of conditions, including atresia and stenosis, annular pancreas, malrotation, duplication cyst, meconium ileus, meconium plug syndrome and neonatal small left colon syndrome, Hirschsprung’s disease, neoplasia, trauma, and other rarer causes. The mode of presentation can be acute or more chronic with systemic upset due to shock. Neonates, more so than older children, with unrecognized intestinal obstruction deteriorate rapidly, show an increase of associated morbidity and mortality and appropriate surgical treatment becomes more hazardous. Early diagnosis depends largely on the prompt detection of obstructive manifestations by the clinician and the subsequent accurate interpretation of radiographic findings and other investigations, leading to definitive treatment, which should always be preceded by appropriate resuscitation/preparation of the infant/child. Management of intestinal obstruction will almost always be surgical, apart from some notable exceptions and all are discussed in more detail. With the advent of pediatric and neonatal intensive care and multidisciplinary care, the morbidity and mortality of cases of intestinal obstruction reported in current series is generally extremely low and mainly determined by the coexistence of other major congenital anomalies (eg, cardiac), delays in diagnosis and treatment or coexisting medical conditions. Newer treatments and future developments may reduce the residual mortality in such cases as ultrashort-bowel syndrome.

Small left colon syndrome in a newborn with cystic fibrosis

A patient is reported in whom neonatal small left colon syndrome (NSLCS) was present with caecal perforation in conjunction with cystic fibrosis, presenting as meconium ileus. The pregnancy, in a 36-year old primigravida, was characterised by alcohol and nicotine abuse but was otherwise normal. There was no maternal diabetes. Management by temporary bowel diversion, in conjunction with pancreatic enzyme replacement, was effective.

Neonatal small left colon syndrome in twins

There are no previous reports of small left colon syndrome in twins. Small left colon syndrome is reported in 2 sets of twins. In 1 set 1 twin had clinical and radiographic signs of small left colon syndrome. The sib was clinically normal and had no radiographic studies. In the other set, both twins had identical clinical and radiographic findings of hyperplastic left colon. This suggests a genetic and/or environmental intrauterine, rather than a postpartum etiology for the small left colon syndrome.

Neonatal small left colon syndrome: L. Rangecroft. Arch Dis Child 54:635–637, (August), 1979

Neonatal small left colon syndrome: L. Rangecroft. Arch Dis Child 54:635–637, (August), 1979

Long-term experiences with carbamazepine (Tegretol) in children with seizures

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Neonatal small left colon syndrome: R. Robles. E. Blesa,C. Jimènez, et al. An Esp Ped 12:447, 1979

Neonatal small left colon syndrome: R. Robles. E. Blesa,C. Jimènez, et al. An Esp Ped 12:447, 1979

Neonatal small left colon syndrome: its relationship to aganglionosis and meconium plug syndrome.

Neonatal small left colon syndrome is a cause of functional colon obstruction in newborn infants, with a high association of maternal diabetes. There has been much confusion regarding its relationship to meconium plug syndrome and aganglionosis. Six cases of aganglionosis (2 in infants of diabetic mothers) were encountered in which the radiographic findings were identical to small left colon syndrome, indicating the need for caution in dismissing aganglionosis solely on the basis of a small left colon seen radiographically in a newborn infant with colon obstruction. Small left colon and meconium plug syndrome are overlapping entities in the total spectrum of functional intestinal obstruction in newborn infants.

Neonatal small left colon syndrome: report of two cases : W. B. Woodhurst and M. R. Kliman. Amer Surg 42/7:479–481 (July), 1976

Neonatal small left colon syndrome: report of two cases : W. B. Woodhurst and M. R. Kliman. Amer Surg 42/7:479–481 (July), 1976

Fat thickness in the neonatal small left colon syndrome

Fat thickness in the neonatal small left colon syndrome

Neonatal small left colon syndrome: Intramural not intraluminal obstruction

We have described a characteristic syndrome of intestinal dysfunction in infants of diabetic mothers. This finding appears to result from a transient intramural dysfunction. Many respond to rectal irrigations alone. However, a significant number will require close observation and possible diversion for persistent partial intestinal obstruction. Failure to recognize persistent obstruction may result in intestinal perforation.