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.