Antenatal Ultrasonographic Features Associated with Segmental Small Bowel Dilatation: An Unusual Neonatal Condition Mimicking Congenital Small Bowel Obstruction

Abstract

Segmental dilatation of the intestine (SDI) is an unusual condition presenting during the neonatal period, with symptoms of obstruction. Late diagnosed cases are also reported. The clinical polymorphism, and the lack of specificity of radiological investigations, make diagnosis difficult. Prenatal detection of abdominal cystic lesions or bowel dilatation has occasionally been reported to be associated with SDI. We herein report two cases of SDI, with a prenatal ultrasonographic suspicion of intestinal abnormality. In both infants, a dilatation of the ileum was found at surgery, without any evident site of obstruction or abnormal histology. SDI must be taken into consideration when a prenatal alert of possible bowel obstruction is not followed by postnatal clinical signs.

Segmental ileal dilatation with supernumerary intestinal muscle coat in a neonate

“…SID is a rare congenital anomaly characterized by sharply demarcated dilatation of gastrointestinal tract without any evidence of mechanical obstruction [ 3 ]. The most common localization of dilated segment is the ileum and followed by the colon, jejunum, and duodenum [ 6 , 7 ].…”

“…SID is encountered in both sexes with a slight male predominance [ 3 ]. The most common clinical presentation is intestinal obstruction, and abdominal pain, anemia, and failure to thrive can be seen in older children [ 3 ]. Anemia is the first sign of SID in patients with heterotopic gastric mucosa.…”

“…SID can also be detected as an intra-abdominal cystic mass in prenatal ultrasonography [ 13 ]. On abdominal X-ray, it is associated with dilated bowel loops with or without air-fluid levels and can be easily misdiagnosed as other causes of intestinal obstruction [ 3 ]. As in our case, contrast enema studies can be performed to differentiate other gastrointestinal anomalies.…”

“…According to the criteria proposed by Swenson and Rathauser, SID is defined as limited bowel dilatation with three- to fourfold increased size, with an abrupt transition between dilated and normal bowel, without any intrinsic and extrinsic barrier distal to the dilatation or abnormal neurological innervation [ 2 ]. Approximately half of the SID cases are seen in the first days of life, and clinical findings of intestinal obstruction are the most common presentation [ 3 ]. Anemia, failure to thrive, and abdominal pain are usually encountered in older children [ 3 ].…”

“…Approximately half of the SID cases are seen in the first days of life, and clinical findings of intestinal obstruction are the most common presentation [ 3 ]. Anemia, failure to thrive, and abdominal pain are usually encountered in older children [ 3 ].…”