Анатомия и физиология: текущие исследования
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Clinical Profile and Outcome in Distal Gastrointestinal Tract Obstruction in Neonates with Special Emphasis on Role of Colostomy and its Complications

Irfan Hussain Bhat, Arif Hussain Sarmast, Nuzhat Samoon, Aijaz A Baba and Sheikh Khurshid

Background: Unlike adults or older children, the intestinal obstruction in neonates in majority of the cases is due to congenital anomalies. The mode of presentation can be acute, with obvious features of obstruction or presentation can also be more subtle and chronic in cases of incomplete or recurring and resolving bouts of obstruction.

Aims and objectives: To determine the various causes, clinical presentation, type of surgical intervention, various types of colostomies, outcome (morbidity and mortality) of neonatal distal intestinal obstruction.

Material and methods: This prospective study was conducted in the Department of Paediatric surgery of our hospital over a period of 2 years (between July 2013 to June 2015) and included all the neonates (age limit of 0 days to 1 month) presenting as lower gastrointestinal tract obstruction. Detailed history, clinical examination, investigations followed by proper surgical intervention if needed was carried out.

Results: Of the total of 170 patients, 117(68.82%) were males and 53 (31.18%) were females with major chunk of babies born in health care facilities, 93 (54.71%), however still a good number of babies were born at home as well, 77 (45.29%).58(34.1%) patients were low birth weight (<2.5 kg) at birth whereas rest of the babies, 112(65.9%) were >2.5 kg. In relation to gestational age, 39 (22.94% ) babies were preterm, 115 (67.64) babies were full term and 16 (9.41%) babies were post term. The presenting features varied significantly with abdominal distension (77.06%), failure to pass meconium (77.64%), vomiting and fluid and electrolyte disturbances being present in most of the patients. A total of 22 patients died with a mortality of 14.10%. It was higher in low birth weight neonates and in babies with co-morbidities (severe congenital anomalies, hypothermia, and severe respiratory embarrassment) and post-operative complications (bleeding diathesis, sepsis).

Conclusions: Neonatal intestinal obstruction is one of the most common paediatric surgical emergencies presenting to our centre and every effort must be made to identify this entity as early as possible so as to address it at the earliest to minimize the morbidity and mortality associated with it.