Discussion
Neonatal intestinal obstruction is so devastating if access to care is
not immediate. This may progress to possible proximal bowel perforation,
aspiration and increased intra-abdominal pressure compromising breathing
as seen in this child who was admitted with an oxygen saturation of 89%
room air (7). As known, access to proper surgical care is still a huge
challenge in developing countries as often are delayed before reaching
the point of care. The mother to this baby came from 100 kilometer
distance away already in a complicated state, distressed and hypoxic
with probable increased intra-abdominal pressure secondary to the
abdomen distension and bowel oedema (2,3). The cause of Perforation in
this neonates was found to be secondary to a more distal obstruction and
eventual perforation was caused by ileal atresia type I (5). The plain
abdominal radiographic findings of dilated small bowel greatly supported
a diagnosis of intestinal obstruction. However, the possibility of
minute perforation couldn’t be excluded since he presented with
additional features of peritonitis (8,9).
The surgical management for ileal atresia reported by Hiller et al is in
favour of primary resection and anastomosis than secondary anastomosis
(14). This neonate was managed by constructing a double-barrel ileostomy
owing to the fact there was gross peritoneal contamination by meconium
and bowel oedema mitigating the risk of the anastomotic leak (15).
Consequently, the neonate deteriorated at home following poor,
inadequate breast-feeding by the mother and eventually died in the
hospital upon readmission from severe acute malnutrition and hypothermia
six weeks later.
Conclusion: A high index of suspicious on concomitant
intestinal perforation in a neonate presenting with intestinal
obstruction and delayed access to surgical care while approaches such as
intestinal diversion should be sought carefully to mitigate serious
consequences of anastomotic leak from primary bowel repair.
Consent
The mother gave written informed consent for the publication of her
baby’s clinical information including the photographs.
Authors contributions
Okidi Ronald wrote the background, discussion of the case and
preparation of the manuscript, Komakech David added background and
summarized the case description, Nahurira violah was involved in the
writing of the abstract and Aber Lucy Diana provided photographs of the
baby and obtained informed consent for publication of the case. All the
authors participated in the management of this case.
Disclosure
All the authors declare no conflict of interests.
Acknowledgement
We thank the in-charge of ICU for providing us with the patient clinical
file for documentation. Our appreciation to all the theatre team members
who participated in the management of this case.
We send our most sincere gratitude to Lacor hospital institutional
research and ethics committee for granting us ethical clearance to
report this case.