Demographic Pattern, Management, and Outcome of Intestinal Atresias Among Neonates in a Tertiary Care Indian Hospital

Objectives: To analyze the incidence, management approach, and outcome of intestinal atresias among neonates in our hospital. Design: Retrospective observational study. Settings: Tertiary care pediatric institute located in eastern part of India. Study period: January 2015 to December 2019. Results: Intestinal atresias constituted 54% of neonatal intestinal obstruction cases ( n = 369). Out of 201 cases of intestinal atresias, only 120 patients presented during first week of life and the male to female ratio was 1.3:1. The mean (±SD) weight at presentation was 2.03 (±0.49) kg and newborns below 1.5 kg were associated with significantly higher mortality ( P =.001). Jejunoileal atresias were found to be the most common type of atresia ( n = 116, 58%) followed by duodenal atresias ( n = 67, 33%). Colonic and pyloric atresias were found in 14 (7%) and 4 cases (2%), respectively. The overall mortality in the present study was 18% ( n = 36) and septicemia was the leading cause. Conclusion: Intestinal atresias were the most common cause of intestinal obstruction and surgical emergency in neonates. Although, there is gradual improvement in survival in these newborns, low birth weight, late presentation, and associated comorbidities are high risk factors. Increased awareness about these congenital anomalies, early referral to tertiary care centers, and timely management can improve the outcome.

Congenital segmental dilatation of intestine with different morphology: A case report

Background: Congenital segmental dilatation of intestine is a rare entity characterized by a localized dilated segment of the intestine. It manifests as neonatal intestinal obstruction. Occurrence with another surgical anomaly may masquerade it and complicate the treatment course. Case Presentation: A 1-day-old male neonate with anorectal malformation underwent colostomy as first stage of the treatment. The stoma did not function postoperatively. At repeat surgery, congenital segmental dilatation of the ileum, with slightly different morphology, was found. Resection of the lesion and ileostomy were formed. Postoperative course remained uneventful. Conclusion: Congenital segmental dilatation of intestine may be missed at initial surgery. Complete surgical resection is curative.

Congenital Segmental Intestinal Dilatation: A Clinical Dilemma

Congenital segmental dilatation of intestine is a rare clinical entity encountered in neonates with very few case reports from world over. It usually presents with symptoms of partial or total obstruction in neonatal period or infancy. We report a case of a preterm baby with segmental dilatation of intestine which was managed surgically. Diagnosis was confirmed intraoperatively as well as histologically. Consideration of this entity in differential diagnosis of neonatal intestinal obstruction may enable for better understanding and more reporting of this rare condition.

Intussusception in a premature newborn: A case report

Background: Intussusception is rare in the neonatal period and even less common in premature babies. Case Presentation: We present a case of a premature newborn with an insidious clinical picture characterized by irritability and multiple vomits. Ultrasound was diagnostic of intussusception. The baby had a jejunal intussusception without any pathological lead point, with a favorable outcome. Conclusion: Intussusception is a rare cause of neonatal intestinal obstruction especially in premature neonates.

Congenital hepatic hemangioma presenting with neonatal intestinal obstruction: A case report

Background: Congenital hepatic hemangioma usually presents with abdominal distension. Rarely it may cause intestinal obstruction. We present a case of congenital hepatic hemangioma causing neonatal intestinal obstruction. Case Presentation: A 4-day-old neonate presented with clinical and radiological features of neonatal intestinal obstruction. On exploration, a loop of jejunum was found adherent with a hepatic mass, arising from the left lobe of the liver. The hepatic mass profusely bled in an attempt of removing the adherent jejunal loop. Thus, the adherent portion was isolated and jejunojejunal end to end anastomosis was done. The hepatic mass along with an adherent small piece of jejunum was also excised. Histopathology showed hepatic hemangioma. The patient is doing fine on the 10-month follow-up. Conclusion: We report a rare presentation of congenital hepatic hemangioma with neonatal intestinal obstruction. Although the optimum therapy for hepatic hemangioma is medical management, at times, surgical resection becomes a necessary option.

Gut lumen formation defect can cause intestinal atresia: evidence from histological studies of human embryos and intestinal atresia septum

Intestinal atresia (IA), a common cause of neonatal intestinal obstruction, is a developmental defect, which disrupts the luminal continuity of the intestine. Here, we investigated (i) the process of lumen formation in human embryos; and (ii) how a defective lumen formation led to IA. We performed histological and histochemical study on 6–10 gestation week human embryos and on IA septal regions. To investigate the topology of embryonic intestine development, we conducted 3D reconstruction. We showed that a 6–7th gestation week embryonic gut has no lumen, but filled with mesenchyme cells and vacuoles of a monolayer of epithelial cells. A narrow gut lumen was formed by gestation week-9, the gut was filled with numerous vacuoles of different sizes, some vacuoles were merging with the developing embryonic gut wall. At gestation week-10, a prominent lumen was developed, only few vacuoles were present and were merging with the intestine wall. At IA septal regions, vacuoles were located in the submucous layer, covered by a single layer of epithelium without glandular structure, and surrounded with fibrous tissue. The mucosal epithelium was developed with lamina propria and basement membrane, but the submucosa and the longitudinal smooth muscle layers were not properly developed. Hence, the vacuoles in IA septum could represent a remnant of vacuoles of embryonic gut. In conclusion, the fusion of vacuoles with the developing intestine wall associates with the disappearance of vacuoles and gut lumen formation in human embryos, and perturbation of these developmental events could lead to IA.