Prenatal and neonatal intussusception

Intussusception found in the 1st month of life is rare and usually discussed as one entity, neonatal intussusception, but in fact, includes the intussusceptions occurring both prenatally and neonatally, of which the clinical presentations and results are different. Four full-term babies with prenatal intussusception presenting as intestinal atresia (IA) and three premature babies with neonatal intussusception mimicking necrotizing enterocolitis (NEC) are presented. Prenatal intussusception, as one of the causes of IA produces prominent signs of intestinal obstruction immediately after birth. Preoperative evaluation usually fails to yield a definitive diagnosis, but surgery is usually performed in time and is successful. In neonatal intussusception, full-term infants usually have a pathological lead point and the colon is almost always involved. A barium enema is thus useful in diagnosis. Premature babies, on the other hand, rarely have a colonic component, and the clinical features are insidious and similar to NEC. This results in diagnostic confusion that may lead to a dangerous delay in appropriate surgical correction. A high level of suspicion about this condition in cases diagnosed presumptively with NEC is important. Serial abdominal sonograms may be helpful in the early diagnosis of neonatal intussusception.     

Idiopathic simultaneous intussusceptions in a neonate

Multiple simultaneous intussusception is a peculiar variety of intussusception. The condition is reported in older children and adults. The occurrence in neonates is an interesting situation. We present one such neonate who had a simultaneous ileo-colic and ileo-ileal intussusception without any specific cause. A review of existing literature revealed only three neonates. The terminology and various aspects of the condition are discussed.     

Therapeutic intussusception in necrotizing enterocolitis: a novel surgical strategy

The optimal operative management of babies with necrotizing enterocolitis (NEC) remains uncertain. We report the case of a premature neonate with advanced NEC where areas of necrotic small bowel were successfully managed by intussusception into adjacent distal intestine and we discuss the merits of therapeutic intussusception as an option in the surgical management of advanced NEC.     

Challenging diagnosis between intussusception and necrotizing enterocolitis in premature infants

Although necrotizing enterocolitis (NEC) is a frequently encountered entity in premature infants in the neonatal intensive care unit, intussusception is extremely rare. Abdominal distension, bilious/non‐bilious gastric residuals and bloody stool are the common clinical findings of both entities. Here we present three cases of intussusception misdiagnosed as NEC, two of which were complicated with intestinal perforation. Similar clinical findings of NEC and intussusception leads to misdiagnosis and delay in treatment, particularly in premature infants with intussusception.     

Intussusception in an extremely premature infant following bacterial sepsis

Intussusception occurring in premature infants is exceedingly rare and shows substantially different characteristics from that in the typical age group or non-premature neonates. We present a case of intussusception in an extremely premature infant following bacterial sepsis, in which necrotizing enterocolitis was initially suspected. The correct diagnosis was made at 35 days old using abdominal ultrasonography, but the general condition of the infant had deteriorated to the point where surgery could not be performed. The patient died of multiple organ failure, and autopsy revealed ileo-ileal intussusception without a recognizable anatomical leading point. Possible mechanisms for this rare clinical entity are discussed.     

新生儿原发性肠套叠临床诊治特点浅析

目的探讨新生儿原发性肠套叠的临床表现及诊断治疗特点。方法对5例新生儿原发性肠套叠的诊治经过进行回顾性分析，探讨新生儿原发性肠套叠的诊治特点。结果5例患儿中，2例有窒息或宫内窘迫病史；5例表现为呕吐，便血3例，腹胀3例，腹壁水肿2例，包块1例；5例作X线平片检查，2例完全梗阻，3例不全梗阻；4例超声检查显示：包块3例，典型的同心圆、套筒表现1例；水压灌肠复位1例失败，全部接受手术治疗，证实为原发性肠套叠，其中小肠套叠2例，回盲型2例，回结型1例；手法复位1例，肠切除吻合4例；死亡1例。结论新生儿肠套叠可以是原发性的.临床表现不典型，可表现为新生儿肠梗阻，术前明确诊断较困难；小肠套叠相对多见；早期超声检查具有诊断意义；早期手术治疗效果满意。     

Colo-colic intussusception in Henoch-Schönlein purpura

Intussusception is the commonest surgical complication of Henoch-Schönlein purpura (HSP), occurring in 1.3%–13.6% of affected children. Colo-colic intussusception is a rare occurrence in HSP, with only three other reported cases. Intussusception in HSP almost always originates in the ileum (90%) or jejunum (7%), and more than one-half of cases (58.4%) are confined to the small bowel. This is in contrast to idiopathic intussusception, where the majority (80%–90%) are ileo-colic and can be diagnosed and reduced by contrast enema.     

Spinal epidural abscess in a neonate

Spinal epidural abscess constitutes a neurosurgical emergency in which early diagnosis and prompt decompression are necessary to avoid permanent cord damage. This entity is rare in premature infants and neonates in whom diagnosis can be challenging. The authors present a case of a premature twin neonate who developed an epidural abscess with complete paraparesis after coagulase-negative Staphylococcus epidermidis bacteremia that was treated with a single-level flavotomy and catheter irrigation.     

Intussusception caused by heterotopic pancreatic tissue in a child

Intussusception is the leading cause of intestinal obstruction in children and is almost invariably idiopathic. Occasionally, there is a lead point for the intussusception. Intussusception caused by heterotopic pancreas (HPT) as the lead point is exceedingly rare. We report a case of intussusception caused by HPT in a child. Clinical and pathologic features and the successful medical and surgical management of the case are discussed.     

Neonatal pneumoperitoneum: a critical appraisal of its causes and subsequent management from a developing country

Background  

The diagnosis and management of neonatal pneumoperitoneum revolves around necrotizing enterocolitis (NEC) in most of the published literature. Although NEC remains the major cause of pneumoperitoneum in a neonate, there are several other causes leading to free air in the peritoneal cavity. A number of case reports have appeared describing pneumoperitoneum in a newborn due to rupture of one particular organ, but there have been only few collective reviews on the subject. The present study shares the experience with neonates admitted with a diagnosis of pneumoperitoneum in a pediatric surgical center of a developing country. The various causes of pneumoperitoneum in a newborn, their management and subsequent outcome are described.     

Association of <Emphasis Type="Italic">Escherichia</Emphasis><Emphasis Type="Italic">coli</Emphasis> O157:H7 with necrotizing enterocolitis in a full-term infant

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency of the neonate. NEC is predominantly seen in premature infants; however, in rare instances it can affect full-term infants as well. Although the pathogenesis of NEC remains elusive, it is well established that bacterial colonization is required for development of this disease. In this report, we present a case of a full-term infant, who developed a very aggressive form of NEC and was found to have Escherichia coli (E. coli) O157:H7 both in stool and blood cultures. Unfortunately, despite aggressive surgical and intensive care management, this infant suffered pan-intestinal necrosis and expired. We were not able to establish the route of transmission. To our knowledge, this is the first report of the association of E. coli O157:H7 with NEC.     

Rare presentation of small bowel intussusception in childhood

Small bowel intussusception complicated simultaneously by volvulus in an older child is rare but clinically significant, necessitating urgent operative management. We report a local case of jejuno‐jejunal intussusception complicated by volvulus and bowel infarction in a 9‐year‐old Chinese girl, with diagnosis made on preoperative computed tomography and confirmed at laparotomy. An intestinal polyp as the lead point for intussusception was identified operatively.     

Necrotizing enterocolitis in the full-term neonate

Necrotizing enterocolitis (NEC) is a relatively common disorder of multifactorial aetiology that primarily affects preterm newborns, but has been reported to occur in the full-term neonate as well. This review focuses on known and recent developments in the epidemiology, pathogenesis, diagnosis, management and prevention of NEC in the full-term neonate.     

Quantitative study of aerobic and anaerobic fecal flora in necrotizing enterocolitis of the newborn infant

A quantitative study of the fecal flora was carried out in 21 neonates with necrotizing enterocolitis (NEC), (4 infants being born at term) and 57 control infants (30 born at term and 27 born before term). In the population as a whole Klebsiella was detected more frequently in NEC than in the controls. This was especially true in premature infants where Klebsiella was found in 65% of the affected infants versus 33% of the controls (p less than 0,05), while no Klebsiella was detected in the 4 term infants with NEC and in 87% of the term controls. These data suggest that Klebsiella could play a role in the pathogenesis of NEC, especially in the premature infant. Therefore, it seems required to avoid the artificial selection of Klebsiella in the neonate.     

Appendicitis with perforartion in a neonate

Appendicitis is a very rare clinical entity in neonates. Preterm and male neonates are commonly affected. It is often seen in association with surgical conditions like Hirschsprung’s disease and necrotizing enterocolitis. Non-specific clinical features result in delay in the diagnosis and predisposes to perforation. The risk of perforation is very high (85%) in neonatal appendicitis. Management includes pre-operative stabilization, appendicectomy and peritoneal drainage in cases of perforation with peritonitis. Prognosis is uniformly poor with mortality rate as high as 70%. Herewith reporting a neonate with multiple perforations who was successfully managed     

Iatrogenic pharyngoesophageal perforation in premature infants.

BACKGROUND: Premature infants are particularly at risk of iatrogenic pharyngoesophageal perforation. It is a rare occurrence but when it does occur it often mimics esophageal atresia. In the light of 10 patients treated in our service and those reported in the literature we have highlighted the diagnostic difficulties and discussed the appropriate management. PATIENTS: Between 1980 and 1995, we treated 10 premature neonates for pharyngoesophageal perforation. Six of these neonates weighed less than 1500 g. Esophageal atresia was the primary diagnosis in 4 cases. The pharyngoesophageal perforation was caused by repeated airway intubation in 3 cases and by overenthusiastic routine postpartum suctioning or nasogastric tube (NGT) insertion in 7 others. Severe respiratory distress occurred in 7 neonates. A plain chest x-ray revealed a large right pneumothorax in 3 cases and an aberrant NGT in 3 other cases. Four neonates had a contrast esophagography and 4 neonates underwent endoscopy. Five cases were treated surgically. In 3 of these, esophageal atresia was the presumptive diagnosis and the perforation was only diagnosed intraoperatively via a right thoracotomy. One neonate required suturing of the perforation and another had a gastrostomy. In all 5 cases a mediastinal drain was left in situ. The 5 remaining neonates were treated conservatively with broad spectrum antibiotics, total parenteral nutrition, a silastic NGT and pharyngeal aspiration. One of these neonates had previously had a laparotomy for a colonic perforation. There was a good outcome in 4 neonates, one of whom required instrumental dilatation for an esophageal stricture. Bronchopulmonary dysplasia developed in 3 cases and necrotizing enterocolitis in 1 other case. Two neonates died. CONCLUSION: An iatrogenic perforation is often difficult to diagnose and can easily be confused with esophageal atresia. Clinical findings, a plain chest x-ray, an esophagography and endoscopy are helpful. Surgery can be avoided in most instances. The outcome is not always favorable especially as premature neonates are at risk of severe concomitant pathology.     

新生儿坏死性小肠结肠炎防治的研究进展

新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)是新生儿较常见的胃肠道疾病,是早产儿死亡的主要原因,其发病机制目前尚不明确.近年来,国内外学者对NEC的危险因素、发病机制、治疗及预防作了大量的深入研究,试图从喂养方式、微生态制剂的应用、病原菌感染的控制、营养因子或细胞因子的干预等手段来减少NEC的发病率和病死率.     

Intussusception in neonates: analysis of 14 Japanese patients

OBJECTIVE: To clarify the clinical features and pathogenesis of intussusception in neonates. METHODS: Fourteen neonates were diagnosed with intussusception between June 1974 and January 2001. Patients were divided into two groups according to whether or not signs were present on the first day of life. The clinical features were interrelated with the pathological findings. RESULTS: All six patients in the group whose signs were present on the first day of life also had intestinal atresia or malrotation. Among patients whose signs began less than 24 h after birth, five of eight patients suffered hypoxia. Moreover, it was very difficult to establish the diagnosis of intussusception, particularly in the group of late-onset type intussusception. CONCLUSIONS: Hypoxic events may play a crucial aetiologic role in the pathogenesis of late-onset neonatal intussusception.     

前白蛋白对重症坏死性小肠结肠炎的诊断价值

目的 了解重症新生儿坏死性小肠结肠炎(NEC)的临床特点,探究前白蛋白(PA)对于重症NEC的诊断价值。方法 对40例NEC新生儿(Ⅱ期29例、Ⅱ期11例)的临床资料及血常规、血生化结果进行研究,采用多因素logistic回归分析以及ROC曲线判断PA在重症NEC诊断中的价值。结果 多因素logistic回归分析发现PA对于重症NEC(≥Ⅱ B期)的诊断具有参考价值。ROC曲线分析显示在重症NEC(≥Ⅱ B期)的诊断中,PA拥有较高的灵敏度(0.870)及特异度(0.647)。结论 PA对重症NEC(≥Ⅱ B期)具有较高的诊断价值。     

Primary Repair of Aortopulmonary Window with an Interrupted Aortic Arch in a Very Low-Birth-Weight Premature Neonate

The aortopulmonary window concomitant with an interrupted aortic arch is a rare occurrence. We successfully performed an emergency one-stage surgical repair of the aortopulmonary window (type 1) concomitant with an interrupted aortic arch (type A) in the case of a very low-birth-weight (1230-g) premature 2-day-old neonate. We describe the diagnosis, surgery, and postoperative course of this rare occurrence.