Benign Transient Non-Organic Ileus of Neonates

Abstract

There are a substantial number of neonates who present with Hirschsprung's disease-like symptoms, but respond very well to conservative therapy. However, once Hirschsprung's disease is ruled out, little attention is paid to these infants, because of the lack of necessity for surgical treatment and their excellent prognosis. The purpose of this study was to elucidate the clinical features of functional ileus of neonates, which we named benign transient non-organic ileus of neonates (BTNIN). Out of 61 neonates referred to our institution with suspected neonatal Hirschsprung's disease (NH), 10 were diagnosed as having NH and 51 as having BTNIN. All the cases of BTNIN showed marked abdominal distension, and 12 showed explosive defecation on digital examination at the first visit. Plain X-ray demonstrated marked whole intestinal dilatation in 12 cases including cases with niveau formation and segmental dilatation. These findings were indistinguishable from those of NH. However, all had a normal anorectal reflex, and rectal suction biopsy revealed normal acetylcholinesterase activity and submucosal ganglion cells. All the cases of BTNIN were treated with periodic glycerin enemas until daily spontaneous defecation was established, which took 2 to 14 months, with an average of 5.0 +/- 2.9 months. None of them showed residual symptoms during the follow-up period.

Clinical Characteristics and Management of Benign Transient Non-Organic Ileus of Neonates: A Single-Center Experience

“…The average duration of treatment was only 4.4 months in our study and has been reported to be 5 months in a previous study 3. Conservative treatment should be periodic or intermittent glycerin enema.…”

“…First reported in 2002,3 BTNIN did not receive much attention from pediatric surgeons because of its favorable clinical course, and very few supportive articles have been published 4,5. However, the age at the definitive surgery of Hirschsprung's disease is far younger than previous decade and one-stage procedure has been popular 6-8.…”

“…A diagnosis of BTNIN was established based on previously published criteria: presence of a non-organic ileus of the neonate excluding Hirschsprung's disease, Hirschsprung's disease-allied disorders, and functional ileus associated with meconium obstruction 3. Nineteen patients were treated during the study period, and no patients were excluded from the study.…”

“…Yamauchi, et al3 first coined the term benign transient non-organic ileus of neonates (BTNIN) in 2002. This entity is likely more common than originally thought, but the detailed characteristics are not fully understood.…”

Cow's milk protein allergy presenting with Hirschsprung's disease–mimicking symptoms

“…Unlike other transient functional intestinal obstruction, such as meconium-related ileus [1], this condition occurs mostly in normal-birth-weight neonates and is not associated with impaired meconium excretion. The authors reviewed 51 cases of the condition and tentatively named it bbenign transient nonorganic ileus of neonatesQ (BTNIN) [2]. The pathogenesis of BTNIN has been totally unknown; however, we observed that BTNIN included cases of CMA [3].…”