Congenital Descending Colonic Stenosis with Perforation of Transverse Colon in a Neonate: A Case Report

Abstract

Colonic atresia and stenosis are rare causes of intestinal obstruction in the infant. Only 10 cases have been reported in Literature since 1966 and only one late-onset case has been reported in Literature until now. We describe the case of a 3 day old baby presenting with abdominal distension, failure to pass meconium and vomiting. X-ray of the abdomen showed dilated gut loops. Exploratory laparotomy was performed. At the junction of descending and sigmoid colon a stenosis was found, laparotomy also revealed a perforation of transverse colon. Transverse colostomy and a mucous fistula of sigmoid colon was performed after resecting stenosing segment and colon distal to perforation site upto stenosing site. Diagnosis was confirmed on histopathology. Colostomy was close after six weaks with uneventful recovery. Considering both the Literature and our case, congenital colonic stenosis should be considered one of the rare differential diagnoses in a neonate presenting as complete or partial intestinal obstruction.

Chronic bowel obstruction from colonic stenosis in early infancy-A report of two cases

“…It is a rare congenital anomaly of the gastrointestinal tract with a reported incidence of 1 in 40,000 births2. The aetiology is largely unknown, but the development of the condition has been associated with fetal mesenteric vascular accidents from fetal intestinal kinks, internal herniation, intussusception, volvulus, and maternal use of cocaine2–4. Colonic stenosis has also been reported from acquired conditions like necrotizing enterocolitis (NEC), however such stenosis commonly involves multiple areas of the large bowel5, 6.…”

“…Colonic stenosis has also been reported from acquired conditions like necrotizing enterocolitis (NEC), however such stenosis commonly involves multiple areas of the large bowel5, 6. Reports indicate that any of the segments of the colon may be affected by the congenital stenosis, but it is commoner in the ascending and descending colon1, 2, 4. Congenital colonic stenosis may present early or late in life depending on the severity of the stenosis2, 7.…”

Colonic stenosis in neonates is not always congenital or complication of necrotizing enterocolitis

“…Review of English literature revealed that the association of HD is well known with colonic atresia, but its association with acquired CS is not well reported. [15][16][17][18][19][20] We presented here 4 cases of acquired CS secondary to HD.…”

“…Rectal biopsy was done to rule out HD in second stage followed by definitive surgery (Duhamel's Pull-through) in third stage. Staged surgery has also been advised by various authors [12,18] but none of them emphasized ruling out HD in cases of CS. Most reported series do not favor or recommend rectal biopsy before definitive surgery for CS either primary or staged [15][16][17][18][19][20].…”

Colonic atresia associated with annular pancreas: An extremely rare and previously unreported association

“…Other theories like failure of recanalization, intestinal perforation, drugs, and environmental factors have been proposed. [ 2 ] A provisional diagnosis of colonic atresia could be made on ultrasound if the colonic diameter is more than 18 mm. Contrast enema study is sometimes required to reach the diagnosis of colonic atresia.…”