Presentation and outcome of treatment of jejunoileal atresia in Nigeria

Abstract

Background: Intestinal atresia is a common cause of neonatal intestinal obstruction. Previous reports from Nigeria have indicated a high mortality rate. This is a report of current outcome review from one tertiary center. Patients and Methods: A retrospective analysis of infants managed for jejunoileal atresia in 10 years (2005–2014). The information retrieved from patients’ records was analyzed using SPSS 17. Results: There were 38 patients (19 boys and 19 girls) aged 1–28 days (median 4 days). Twenty-four patients (63.2%) presented after 48 h of life. Twenty-five (65.8%) had jejunal atresia and 13 (34.2%) had ileal atresia. Six patients had associated anomalies. The most common atresia was type III (39.5%, 15 patients). Twenty-eight (73.7%) patients had a resection of the atresia and anastomosis and others had enterostomies. Total parenteral nutrition and neonatal intensive care support were not available during the period of the study. Bowel function was established within 1 week and 27 (71.1%) patients commenced oral feeding. Twenty-six (68.4%) patients had postoperative complications resulting in prolonged hospital stay of 2–44 days (median = 13). Mortality was 34.2% (13 patients). Factors that significantly affected mortality were intestinal necrosis at presentation, postoperative complications, and severe malnutrition. Conclusion: Intestinal atresia is still associated with unacceptably high morbidity and mortality, due to late presentation, and lack neonatal intensive care services and parenteral nutritional support. Efforts need to be intensified to address these factors to improve outcome.

Patterns and surgical outcome of neonatal small bowel obstruction: a single center experience from Ujjain, India

“…7,15 Vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities (VACTREL) anomalies are known in neonates with intestinal obstruction and contribute to increased morbidity and mortality in these neonates. 9,11,13,14 The complications observed in our study (Table 3) are comaprable to other international studies and Indian studies. 9,[11][12][13][14] A comparatively higher mortality rates are observed from studies reported from low-middle income countries.…”

“…9,11,13,14 The complications observed in our study (Table 3) are comaprable to other international studies and Indian studies. 9,[11][12][13][14] A comparatively higher mortality rates are observed from studies reported from low-middle income countries. 5 Some causes for this high mortality are prematurity, late presentation, associated congenital anomalies, complications of surgery as well as lack of intensive care facilities.…”

“…The most common presentation of neonatal small bowel obstruction in our study was vomiting or bilious vomiting, which along with abdominal distension is the most common clinical picture of bowel obstruction in neonates. 2,6,8,9 Although, none of these clinical features are pathgnomic of intestinal obstruction, when considered together they are should alarm the health care workers to consider intestinal obstruction and such babies should be evaluated or referred if facilities for evaluation are not available. Other clinical features seen in our study were visible bowel loops, evidence of dehydration and maternal polyhydramnios.…”

“…Other clinical features seen in our study were visible bowel loops, evidence of dehydration and maternal polyhydramnios. 2,6,8,9 Duodenal and jejunal atresia are associated with maternal polyhydramnios in about one-fourth of cases. 6,10,11 About 30% of the anomalies were identified in antenatal ultrasound, because of which the lesions could be anticipated and a management plan was developed for the treatment of neonate.…”

“…Hyperkalemia and prolonged jaundice are known clinical findings in neonates with intestinal obstruction. 6,9,12 Most neonates presented late. This could be due to high proportion of extra-mural neonates in the study and mainly due to delay in referral.…”