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.