Neonatal Intestinal Obstruction-Four Year Experience

Abstract: Aim of study: To study the aetiology and frequency, sex incidence, age of presentation, management and outcome of neonatal intestinal obstruction. Material and Methods: This prospective study of 316 neonates with intestinal obstruction was conducted over a period of 4 years from November 2009 to October 2013 at single institute. These cases were managed by various surgical procedures. Their epidemiology, day of presentation, associated anomalies and outcomes were studied. Results: A total of 316 neonates (277 males and 39 females) were operated for intestinal obstruction. 268(84.81%) neonates presented in the 1 st week of life. Imperforate anus occurred in 206 (65.19%).Small bowel atresia accounted for23 (7.27%) cases while duodenal atresia was seen in19(6.01%) patients. Infantile hypertrophic pyloric stenosis and Malrotation each occurred in 14 (4.43%) patients; Hirschsprung’s disease in 18(5.69%), Necrotising Enterocolitis in 12(3.79%), Meconium disease of newborn in 9(2.85%) while colonic atresia was seen in one (0.3%) patient. Colostomy was performed in 145(45.88%), Pouchostomy in 15(4.74%) and Cutback anoplasty in 56(17.72%) patients. Ramsted’s Pyloromyotomy in 13(4.11%)%) neonates, Laparoscopic Pyloromyotomy in 1(0.3%),Kimura’s Duodenoduodenostomy in 19(6.01%) ,End to Back anastomosis in 24(7.59%) , End to End anastomosis in 7(2.21%) , Multiple anastomosis in 2(0.6%) , Enterotomy with irrigation in 7(2.21%) , Ladd’s procedure in 14(4.43%) , ,Single stage transanal pull through in 8(2.53%) , Ileostomy in 2(0.6%) , Single stage Abdominoperineal pull through in 2(0.6%), Levelling colostomy in 6(1.89%) ,Peritoneal drain insertion under Local anaesthesia in 5(1.58%) . Overall mortality was 13.60%. Conclusion: Intestinal Obstruction is the most common surgical emergency in neonatal period. Early and accurate diagnosis is paramount for proper patient management. The etiology, mode of presentation, morbidity and outcome of surgery of intestinal obstruction in neonates in our study were not significantly different from other studies.