Abdominal abscess as a cause of intestinal obstruction in the newborn infant (original) (raw)

A Newborn with Distended Abdomen

A male neonate was born to a 35-year-old mother at an outside hospital at 39 1/7 weeks gestation via emergency cesarean section due to decreased fetal movements. The infant had respiratory distress secondary to meconium aspiration and was noted to have a large, distended abdomen at birth. Subsequent ultrasound confirmed hepatosplenomegaly with no evidence of liver mass or ascites. By report, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase were initially within the reference intervals, but the patient had a prolonged INR (international normalized ratio) and hypoalbuminemia, supporting liver dysfunction. The infant was transferred to our institution for specialized care owing to hepatosplenomegaly, hypoglycemia, and coagulopathy of unknown etiology. On admission, the infant was additionally noted to be mildly pancytopenic, with increased lactate and ammonia. Initially, infectious etiologies were of primary concern given the history of meconium aspiration and the history of hepatosplenomegaly, which may be a presenting feature in patients with congenital infection. However, an extensive infectious disease workup was negative and included screens for hepatitis A, B, and C, HIV, herpes simplex virus, cytomegalovirus, Epstein-Barr virus, parvovirus, enterovirus, toxoplasmosis, and blood, urine, and stool cultures.

The acute abdomen in the newborn

Seminars in Fetal and Neonatal Medicine, 2006

Introduction: clinicians must be aware of the wide range of disorders causing acute abdomen in the newborn, a frequent condition that causes challenging problems from many aspects. Aims: to evaluate our incidence of acute abdomen in the newborn, main aetiologies, antenatal diagnosis, clinical presentation and evolution. Methods: a retrospective chart review at a tertiary centre neonatal intensive care unit, from 1997 to 2006. Results: 233 (4.9%) out of 4743 newborns had acute abdomen. Conditions causing abdominal distension were the most frequent (39.5%), followed by conditions causing peritonitis (33.9%), abdominal wall anomalies (23.6%), functional obstructions (1.7%), and bleeding disorders (1.3%); 158 (67.8%) patients underwent surgical intervention, and 39 (16.7) were deceased. Antenatal diagnosis rate was 50%. Conclusions: some conditions associated to acute abdomen in the newborn are obvious, but others are rare and provide challenging problems in respect to diagnosis and treatment. Antenatal diagnosis, early recognition and timely transfer for surgery may avoid deterioration and loss of functioning bowel.

Surgical experience with necrotizing enterocolitis in the infant

Journal of Pediatric Surgery, 1967

is a highly lethal disease of the newborn, primarily seen in premature infants, characterized by a clinical pattern of gastric retention, bile vomitus, abdominal distention and bloodstreaked and occasionally diarrheal stools. The clinical picture may mimic intestinal obstruction initially, and perforation is common. Necrotizing enterocolitis has been a poorly defined entity for many years. Some of the previous reports of functional ileus, 1 intra-abdominal abscesses/ spontaneous perforation of the ileum/ appendicitis, 4,~ and colitis with perforation 6 in the newborn infant appear to represent the same entity. This condition is to be distinguished from the enterocolitis which may occur in aganglionosis where the process is related to obstruction, although the actual pathogenesis is unknown/ The purpose of this report is to present the surgical management that has evolved from a study of the clinical and roentgenologic features observed in 25 patients between 1955 and 1966. HISTORICAL BACKGROUND Early reports that seem to represent this entity appeared between 1838 and 1891. 8-1~ The first survival following surgery is attributed to Agerty and his co-workers in 1943. la More recently other cases have appeared in papers on intestinal perforation or peritonitis in the neonatal period 2,r_,,13 and many descriptive reports of necrotizing enterocolitis have appeared in the European literature. 14-~2 In the last few years two papers from this institution have further defined the roentgenographic findings and clinical picture.-~'-2~ CLINICAL MATERIAL Twenty-five cases, including 18 females and 7 males, were encountered at the Babies Hospital, New York City, between 1955 and 1966. The incidence of prematurity was high; only 7 patients in the group weighed more than

Neonatal intestinal obstruction due to absence of intestinal musculature: A new entity

Journal of Pediatric Surgery, 1967

ECENTLY, WE encountered a newborn with what we thought was meeonium ileus with meconium peritonitis which was unusual because both layers of the muscularis were congenitally absent in multiple large zones of the small intestine. A review of the literature failed to reveal a similar report. CASE REt'O~T A white male was born at 37 weeks of gestation after an uneventful pregnancy to a gravida IV, para III mother and on the first day of life, was noted to have a distended abdomen with prominent abdominal veins. Two other siblings died in infancy of multiple congenital anomalies but autopsy records were unobtainable. The baby was well-developed, well-nourished, conscious, irritable and in moderate distress. Birth weight was 2523 Gm. Bowel sounds were high pitched and the Madder was empty. Rectal examination revealed a patent rectum, and a rectal tube inserted 17 era. produced no meconium. Blood count revealed hemoglobin of 15.5 Gin. per cent with a normal retieulocyte count, red blood cells and hematocrit. Feedings of glucose water at 12 hours were followed by mild spitting. Milk was given on the second day and more regurgitation was observed. Abdominal distention persisted and vomiting of green, foul-smelling material began. A tap water enema with 1% hydrogen peroxide was given, with no results. Roentgenograms of the abdomen demonstrated small bowel obstruction with no gas in the colon. Electrolytes were within normal limits and CO~ content 23 mEq./L. A gastric tube was inserted and intravenous fluids were administered. At 52 hours, laparotomy showed a small intestine that looked like "one sausage attached to another" from the second portion of the duodenum to the cecum. Short lengths of normal appearing intestine followed distended intestine 13-15 em. in length and again the intestine was reduced to its normal caliber for 2-50 cm. (Fig. 1). The surgeon, unaware of the unusual pathology, attempted to resect all the distended portions of the small bowel segments without muscle and anastomose bowel of normal caliber. Five such connections were made. The baby tolerated this surgical procedure poorly. Cyanosis and shallow respirations did not respond to oxygen and he expired in the tenth post-operative hour. The surgical specimen consisted of 5 segments of small intestine (Fig. 1). The shortest measured 2 cm. in length by 1 cm. in diameter, and the longest was 50 cm. in length and 3 cm. in diameter. The serosa of all the segments was covered focally by fibrinous exudate. On opening, no area of complete obstruction was noted. The lumen contained thick, sticky, green meconium. The mueosa was congested with flattening of the folds in the dilated segment. Microscopically there was segmental absence of muscular layers (Fig, 2). The mucosa, lamina propria of the mucosa and submucosa were present and appeared normal. The outer-most portion of the submucosa was lined by mesothelial cells. The other segments contained all the layers of the intestine.

The Approach to Common Abdominal Diagnoses in Infants and Children

Pediatric Clinics of North America, 1998

An original report by Hirschsprung, presented at the Pediatric Congress in Berlin in 1886 and subsequently published in 1887, focused the attention of clinicians on the dilated proximal bowel segment in this This paper, titled "Constipation of the newborn due to dilatation and hypertrophy of the colon," effectively (but incorrectly) guided therapy for over 50 years. This can be seen in Abdominal Surgery of Infancy and Childhood by Ladd and Gross, published in 1941.-The coauthors (ostensibly the Fathers of Pediatric Surgery) noted that the defect was thought to be deficient parasympathetic innervation or overactive sympathetic innervation to the affected (dilated) bowel. Treatment recommendations were parasympathetic stimulants, anal dilatation, cecostomy, local resection of the dilated colon, and total abdominal colectomy (in that order, performed in a total of 39 patients). We now know that all of these recommendations were ill-advised and flirt with disaster because they treated the result of the functional obstruction (the dilated colon) and not the cause.

Solitary intestinal fibromatosis as a cause of bile vomiting in a neonate

Journal of Pediatric Surgery, 2000

The authors describe a 3-day-old newborn admitted with signs of intestinal obstruction caused by solitary intestinal fibromatosis (SIF). This is a very rare lesion, which has an excellent prognosis. The differential diagnosis of bilious vomiting in a neonate caused by other than tumorous processes in the neonatal intestine is extensive. Probably this kind of lesion is more frequent in the neonatal period than thought until now but underdiagnosed because of the diffi-culty of diagnosis. Therapy of choice is wide local excision, and prognosis is excellent. J Pediatr Surg 35:643-645. Copyright 2000 by W.B. Saunders Company. INDEX WORDS: Solitary intestinal fibromatosis; bile vomiting; intestinal obstruction; newborn.