Neonatal Bowel Obstruction
Section snippets
Intestinal atresias
Obstructions of the pylorus, duodenum, jejunum, ileum, and colon collectively are the most common causes of neonatal bowel obstruction. Approximately greater than 1:4000 live births are affected.
Malrotation
The incidence of malrotation is estimated at approximately 1 in 6000 live births. Autopsy studies suggest that the true incidence may be as high as 1% of the total population.67
Intestinal rotation and fixation is normally an orderly sequence of embryologic events in early fetal development. Rapid intestinal growth after the fifth week of gestation results in herniation of the growing midgut through the umbilical ring. The superior mesenteric artery (SMA) functions as the central axis of an
Meconium disease
MI is estimated to account for 10% to 30% of neonatal ICU bowel obstructions.83, 84 The incidence in the United States is approximately 1 in 3000 live births per year. The intestinal lumen is intact in MI but functionally obstructed by the thick, viscid protein-rich meconium, which adheres to the wall of the bowel causing a blockage.
Approximately 15% of patients with CF develop MI. Conversely, greater than 95% of patients with simple MI have CF.85, 86 Extremely low-birth-weight infants may also
Hirschsprung disease
The incidence of HD is estimated at approximately 1 in 5000 live births.100, 101 The male-to-female ratio is generally approximately 4 to 1, but in long-segment disease the ratio is equal.102
The familial incidence of HD is approximately 3.5% to 8% in most reports.103 If total colonic disease is present in the family, however, there is a 13% to 20% incidence. If total intestinal aganglionosis (rare) is present, the familial incidence is approximately 50%. The disease is a gender-linked
Imperforate anus
The incidence of ARMs is approximately 1 in 5000 live births, with a slight male predominance.
ARMs have a heterogeneous etiology, probably as a result of both genetic and environmental factors, although precise causation remains unknown. Several chromosomal abnormalities (trisomies 13, 18, and 21) and syndromic associations have been described, but most cases are sporadic.122
The incidence of associated anomalies is approximately 50% to 60%—the more proximal the anatomic ARM defect, the higher
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