Patterns and surgical outcome of neonatal small bowel obstruction: a single center experience from Ujjain, India
Keywords:Small bowel obstruction, Neonatal surgical emergency, Clinical features, Malrotation, Intestinal obstruction, Ujjain
Background: Neonatal small bowel obstruction is the most commonly encountered paediatric surgical emergency worldwide and in India. The objective of this study was to study the prevalence and spectrum of neonatal small bowel obstruction.
Methods: A retrospective chart review of all neonates aged between 1-28 days that underwent surgery for small intestinal obstruction between January 2017 to January 2019 at Department of Paediatric Surgery, R.D. Gardi Medical College, Ujjain, MP. A predesigned questionnaire was used to collect demographic, clinical and outcome related information. Exploratory laparotomy and type of surgical intervention was done as per the cause.
Results: A total of 52 neonates (M: F ratio 1.74: 1) were included in the study. The most common clinical features were vomiting (92%), bilious vomiting (85%) and abdominal fullness (75%) and laboratory feature was leucocytosis (42%) and thrombocytopenia (31%). Most (66%) neonates presented between 2-7 days and belonged to rural areas (65%). The two most common final diagnosis were malrotation (56%) and intestinal atresia (23%). Associated anomalies were seen in 29% [vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities association (8%) and congenital heart disease (8%)]. The mean (±SD) duration to reach full feeds and duration of neonatal intensive care unit stay was 6.2±1.3 and 14.1 (±5) days, respectively. Complications were seen in 20% cases, most common being early bowel obstruction. A total of 6 (11.5%) neonates died in the post-operative period, 83% because of sepsis.
Conclusions: Small bowel obstruction is common neonatal surgical emergency. Most common cause is malrotation and intestinal atresia. Neonatal sepsis is the most common underlying cause of death post-operatively.
Boyle B, Addor MC, Arriola L, Barisic I, Bianchi F. Csaky-Szunyogh M, et al. Estimating Global Burden of Disease due to congenital anomaly: an analysis of European data. Arch Dis Child Fetal Neonatal Ed. 2018;103(1):F22-8.
Juang D, Snyder CL. Neonatal bowel obstruction. Surg Clin North Am. 2012;92(3):685-711.
Farmer D, Sitkin N, Lofberg K, Lofberg K, Donkor P, Ozgediz D. Surgical Interventions for congenital anomalies. Essential Surgery: Disease Control Priorities. 2015;3(1):1-45.
Gupta DK, Charles AR, Srinivas M. Pediatric surgery in India- a specialty come of age?. Pediatr Surg Int. 2002;18(8):649-52.
Sitkin NA, Ozgediz D, Donkor P, Farmer DL. Congenital anomalies in low- and middle-income countries: the unborn child of global surgery. World J Surg. 2015;39(1):36-40.
Maqbool ABC, Lecouras CA. Intestinal atresia, stenosis and malrotation. In: Kliegman R, Stanton B, St. Geme JW, Schor NF, Behrman RE, Nelson WE, eds. In: Nelson Textbook of Pediatrics. 21st ed. Phialdelphia, PA: Elsevier; 2019: 1950-1954.
Peters B, Oomen MW, Bakx R, Benninga, M. A. Advances in infantile hypertrophic pyloric stenosis. Expert Rev Gastroenterol Hepatol. 2014;8(5):533-41.
Muratore CS, Tracy TF. Neonatal Bowel Obstruction. In: Bland KI, Büchler MW, Csendes A, Sarr MG, Garden OJ, Wong J, eds. Gen Surg. London: Springer; 2009.
Sholadoye TT, Mshelbwala PM, Ameh EA. Presentation and outcome of treatment of jejunoileal atresia in Nigeria. Afr J Paediatr Surg. 2018;15(2):84-7.
Adams SD, Stanton MP. Malrotation and intestinal atresias. Early Hum Dev. 2014;90(12):921-5.
Correa C, Mallarino C, Pena R, Rincon LC, Gracia G, Zarante I. Congenital malformations of pediatric surgical interest: prevalence, risk factors, and prenatal diagnosis between 2005 and 2012 in the capital city of a developing country. Bogota, Colombia. J Pediatr Surg. 2014;49(7):1099-103.
Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, Engum SA. Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg. 1998;133(5):490-6.
Rattan KN, Singh J, Dalal P. Neonatal duodenal obstruction: a 15-year experience. J Neonatal Surg. 2016;5(2):13.
Verma A, Rattan KN, Yadav R. Neonatal Intestinal Obstruction: A 15 Year Experience in a Tertiary Care Hospital. J Clin Diagn Res. 2016;10(2):SC10-3.
Vinycomb TI, Laslett K, Gwini SM, Teague W, Nataraja RM. Presentation and outcomes in hypertrophic pyloric stenosis: an 11-year review. J Paediatr Child Health. 2019;55(10):1183-7.