Filth, impurity, and threat

In many religions, body secretions have been regarded as impure or dangerous. Meconium, the pitch-like substance filling the gut at birth, was considered the embodiment of impurity and actively driven out from the newborn’s body. The custom was advantageous by breaking the taboo on colostrum consumption. Passing the meconium before birth was considered a bad omen. The claim that it indicated fetal death led to intense debates between the Parisian surgeons Viardel and Mauriceau. In 1798, Scheel described meconium aspiration into the airways, a severe disease still causing 1000 deaths annually in the US in 2008. Meconium ileus resulted from a hardened substance within the gut, linked to cystic fibrosis of the pancreas by Landsteiner in 1905. Meconium peritonitis, described by Morgagni in 1751, resulted when the dilated gut perforated during fetal life. A series of meconium occlusion and peritonitis were described in 1877 among infants admitted to the St. Petersburg Foundling Hospital. For centuries, ‘expelling’ the meconium was a postnatal routine with similarities to exorcism, freeing the child from evil.

Pattern and outcome of neonatal gastrointestinal surgical emergencies: A prospective analysis.

Objectives: This study is aimed at determing the pattern and treatment outcome of neonatal gastrointestinal surgical emergencies. Study Design: Prospective Descriptive study. Setting: DHQ Teaching Hospital Sahiwal. Period: January 2018 to December 2019. Material & Methods: All neonates (<28 days old) who underwent surgery for acute gastrointestinal emergency during the study period were included. Newborns more than 28 days and diseases such as esophageal atresia, esophageal atresia with trachea-esophageal fistula, diaphragmatic hernia, omphalocele, gastroschisis and infantile hypertophic pyloric stenosis were not included in the study. Results: A total of 104 cases of neonatal gastrointestinal surgical emergency were included in the study. The most common cause was anorectal malformation 37(35.57%), followed by intestinal atresia 26(25.0%), Hirschsprung disease 13(12.50%), necrotizing enterocolitis 9(8.65%), intestinal malrotation 8(7.69%), meconium ileus 7(6.73%) and others 4(3.84%). Males were 59(56.73%), females 45(43.26%) and male to female ratio 1.3:1. Mean weight was 2.62kg, ranging from 1.5 to 4.4kg. Post-operative complications were septicemia 26(25.0%), wound infection 17(16.34%), respiratory problems 19(18.26%). Mortality rate in necrotizing enterocolitis was 55.55%, meconium ileus 42.85% and intestinal atresia 38.46%. Mortality rate in premature neonates was 48.0% and mature 12.65%. Overall mortality rate was 21.15%. Conclusions: Anorectal malformation is the commonest cause of neonatal gastrointestinal surgical emergency. Necrotizing enterocolitis, intestinal atresia and meconium ileus are the neonatal surgical diseases with high mortality rate. Surgical outcome depends on the complexity of the disease. Sepsis, late presentation, prematurity and low birth weight are significant contributory factors for high morbidity and mortality.

Radiological diagnosis of microcolon in a 5-day old neonate: a case report

Microcolon is a radiographic feature of a low intestinal obstruction that result from intrauterine underutilization or what is term unused colon. The finding of microcolon on contrast enema study in newborn with distended abdomen usually suggests jejunoileal obstruction, jejunoileal atresia, meconium ileus, or occasionally totals colonic agangliosis. We are therefore presenting this case to highlight the wonders that imaging will perform in prompt diagnosis and management of this condition.