Case description

A four (4) day old neonate, born to a 21-year-old primiparous mother delivered at term with a birth weight of 2.30 kg was admitted as a referral from another health unit with failure to pass stool associated with abdominal distension, vomiting of non-bilious content and irritability since birth. There was no yellowing of eyes or skin and he was able to breastfeed well and passed urine normally.
Clinical examination : He was ill-looking, irritable, febrile at 38.3oC, with pink mucosal membranes, and was mildly dehydrated. He was in respiratory distress, respiring at 65 breaths per min with oxygen saturation of 89% on room air. The chest had normal air with normal breath sound and percussion note. The abdomen was grossly distended with visible collateral veins, diffusely tender with guarding. Upon digital rectal examination, a normal anus with a normal anal tone, no perineal fistula, and empty rectum. Noted the absence of blast sign.
Investigation : Abdominal Ultrasonography revealed bowel distension with gas and no peristaltic movement. Supine abdominal X-ray revealed grossly distended bowel loops (Figure 1). A full haemogram showed leukocytosis and granulocytosis (Leucocyte count of 13,380 cell/mL and granulocytes count of 11,010 cells/ mL). Haemoglobin count of 14.1 g/dL.
Management : A nasogastric suction tube and a urinary catheter inserted. Intravenous resuscitation was done with Modified Ringer Lactate and operated. Intraoperative findings of a grossly distended ileum, 15 cm proximal to the ileocecal junction (ICJ) for a length of 16.0 cm and a perforation 18.0 cm form the ICJ with edematous bowel and intraperitoneal contamination (Figure 1). A collapsed distal bowel with a transluminal septum at the point of obstruction with intact bowel continuity. Resected the 2.0 cm bowel including the septum and created a double barrel ileostomy (Figure 1). He was managed in intensive care unit (ICU) postoperatively till discharged with a diagnosis of type I ileal atresia with terminal ileal perforation. Six weeks later, he developed severe acute malnutrition, hypothermia, and dyspnea and passed on in hospital upon re-admission.