DOCSLIB.ORG

Jejunal Atresia Associated with Idiopathic Ileal Perforation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Jejunal Atresia Associated with Idiopathic Ileal Perforation Full text online at http://www.jiaps.com Case Report Jejunal atresia associated with idiopathic ileal perforation P. C. Das, Rakesh Rai1, Grover J. Lobo1 Departments of Pediatric Surgery and 1General Surgery, Fr. Muller Medical College and Hospital, Mangalore, Karnataka, India Correspondence: P. C. Das, Department of Pediatric surgery, Fr Muller Medical College and Hospital, Mangalore, Karnataka - 575 002, India. E-mail: [email protected] ABSTRACT Jejunoileal atresia is one of the common causes of neonatal intestinal obstruction. Intestinal perforation with meconium peritonitis in the neonatal period, which carries a high mortality rate, is also common. The association of jejunal atresia with idiopathic ileal perforation is very rare. KEY WORDS: Intestinal perforation, idiopathic ileal perforation, jejunoileal atresia, meconium peritonitis INTRODUCTION the patient underwent laparotomy on the second day. During laparotomy, type-1 jejunal atresia was found Bowel obstruction in the newborn is one of the at approximately 10 cm distal to the D-J flexure, most common surgical problems, and its successful and a single distal ileal perforation was observed on management depends upon both timely diagnosis and the antimesenteric side with evidence of meconium prompt therapy. Intestinal atresia is one of the three peritonitis [Figure 1]. The entire part of the gut distal common causes of neonatal intestinal obstruction, the to the atresia was unused and collapsed. Further, there other two being Hirschsprung’s disease and anorectal was no evidence of gut inflammation. Jejunal atresia was malformation. Among the types of intestinal atresias, treated by tapering jejunoplasty and end-to-side jejuno- jejunoileal atresia is the most common one. Unlike jejunostomy by using a transgastric jejunostomy infant duodenal atresia, it is less commonly associated feeding tube. Ileal perforation was treated with resection with Down’s syndrome, malrotation and congenital and anastomosis. Feeding was started through the cardiac defects.[1] We report a case of jejunal atresia transgastric jejunostomy tube on the 4th post-operative associated with distal ileal perforation. On search of day. Postoperative recovery was uneventful. The baby English literature, we find only one case of atresia with perforation in distal atretic segment.[2] CASE REPORT A full-term male neonate weighing 2.8 kg was born by spontaneous vaginal delivery. The child cried immediately after birth. Antenatal sonogram showed dilated bowel loops suggestive of intestinal obstruction. The mother did not had polyhydramnios during pregnancy. The child was admitted to the neonatal intensive care unit. He was active, pink and stable. Cardiovascular system was normal. He had upper abdominal distension without any mass. An abdominal erect x-ray showed three air-fluid levels in the upper half of abdomen with the distal half being gasless. No free air was found in the abdomen. Renal function Figure 1: Proximal jejunal atresia (type-1). The tip of the artery forceps test was normal. With the diagnosis of jejunal atresia, indicates the site of distal ileal perforation J Indian Assoc Pediatr Surg / Apr-Jun 2008 / Vol 13 / Issue 2 88 Das, et al.: Jejunal atresia with idiopathic distal perforation was discharged after two weeks. Histopathological not properly treated during preoperative, operative and examination of the resected perforated ileum showed postoperative period. Today, mortality and morbidity single perforation with congestion and hemorrhage in of these cases can definitely be reduced with good ICU the submucosa. There was no evidence of necrotizing care, advanced anesthesia, proper antibiotics, early enterocolitis (NEC). Ganglion cells were present in the surgery and total parenteral/enteral nutrition. resected segments. ACKNOWLEDGEMENT DISCUSSION We are grateful to the Dean of Fr. Muller Medical College Jejunoileal atresia is the most common type of intestinal and the Medical Superintendent of Fr. Muller Hospital, atresia. There are several reports of non-NEC-related Mangalore for allowing us to publish this paper. neonatal intestinal perforation in the literature.[3-5] [2] Sajja et al. reported the first case of duodenal atresia REFERENCES associated with idiopathic small bowel perforations. [2] Possibly, our case is the second a similar case report 1. Grosfeld JL. Jejunoileal atresia and stenosis. In: Welth KJ, (perforation distal to the site of atresia). It is not yet Randolph JG, Ravitch MM, et al, editors. Pediatric surgery. 4th ed. proved whether idiopathic (non-NEC-related) bowel Chicago: Year Book Medical Publishers, Inc; 1986. p. 838-48. 2. Sajja SB, Middlesworth W, Niazi M, Schein M, Gerst PH. Duodenal perforation with intestinal atresia proximal to the site atresia associated with proximal jejunal perforations: A case report of perforation share a common etiology or it is just a and review of the literature. J Pediatr Surg 2003;38:1396-8. coincidence. Jejunoileal atresia is caused by mesenteric 3. Litwin A, Avidor I, Schujman E, Grunebaum M, Wilunsky E, vascular accident during the fetal life, whereas Wolloch Y, et al. Neonatal intestinal perforation caused by congenital defects of the intestinal musculature. Am J Clin Pathol duodenal atresia is due to the failure of vacuolization 1984;81:77-80. [1,6,7] from the solid-cord stage of development. The 4. Weinberg G, Kleinhaus S, Boley SJ. Idiopathic intestinal etiology of idiopathic intestinal perforation is not perforations in the newborn: An increasingly common entity. J completely known. Various causes suggested for the Pediatr Surg 1989;24:1007-8. 5. Mintz AC, Applebaum H. Focal gastrointestinal perforations not idiopathic intestinal perforation are the absence or associated with necrotizing enterocolitis in very low birth weight thinning of muscularis propria, absence of muscular neonates. J Pediatr Surg 1993;28:857-60. layer, excessive resorption of muscularis as a part of 6. Koga Y, Hayashida Y. Intestinal atresia in fetal dogs produced regression of the omphalomesenteric duct and localized by localized ligation of mesenteric vessels. J Pediatr Surg [2,8] 1975;10:949-53. ischemic process. Intrauterine cocaine exposure has 7. Puri P, Fijimoto T. New observations on the pathogenesis of been reported as a cause of non-NEC-related intestinal multiple intestinal atresias. J Pediatr Surg 1988;23:221-5. perforation.[9] The site of perforation of idiopathic 8. Tatekawa Y, Muraji T, Imay Y, Nishijima E, Tsugawa C. The intestinal perforation has been reportedly found in the mechanism of focal intestinal perforations in the neonates with low birth weight. Pediatr Surg Int 199915:549-52. stomach, jejunum, ileum and colon – ileum being the 9. The TG, Young M, Rosser S. In-utero cocaine exposure and [2] most common site. Diagnosis of intestinal perforation neonatal intestinal perforation: A case report. J Natl Med Assoc with proximal intestinal atresia is only possible during 1995;87:889-91. laparotomy. The classical finding of pneumoperitoneum 10. Raghuveer G, Speidel B, Marlow N, Porter H. Focal intestinal perforations in preterm infants are an emerging disease. Acta will never be observed in these types of cases by using Pediatr 1996;85:237-9. the following techniques: x-ray ultrasound, and CT 11. Zamir O, Goldberg M, Udassin R, Peleg O, Nissan S, Eyal F. abdomen. This is because of the presence of proximal Idiopathic intestinal perforation in the neonate. J Pediatr Surg atresia. Mortality and morbidity of idiopathic intestinal 1988;23:335-7. perforation with meconium peritonitis remains high. [10,11] Prognosis of patients with intestinal atresia with distal Source of Support: Nil, Confl ict of Interest: None declared. idiopathic intestinal perforation will be worse if it is 89 J Indian Assoc Pediatr Surg / Apr-Jun 2008 / Vol 13 / Issue 2.
Load more

Recommended publications
  • Megaesophagus in Congenital Diaphragmatic Hernia
    Megaesophagus in congenital diaphragmatic hernia M. Prakash, Z. Ninan1, V. Avirat1, N. Madhavan1, J. S. Mohammed1 Neonatal Intensive Care Unit, and 1Department of Paediatric Surgery, Royal Hospital, Muscat, Oman For correspondence: Dr. P. Manikoth, Neonatal Intensive Care Unit, Royal Hospital, Muscat, Oman. E-mail: [email protected] ABSTRACT A newborn with megaesophagus associated with a left sided congenital diaphragmatic hernia is reported. This is an under recognized condition associated with herniation of the stomach into the chest and results in chronic morbidity with impairment of growth due to severe gastro esophageal reflux and feed intolerance. The infant was treated successfully by repair of the diaphragmatic hernia and subsequently Case Report Case Report Case Report Case Report Case Report by fundoplication. The megaesophagus associated with diaphragmatic hernia may not require surgical correction in the absence of severe symptoms. Key words: Congenital diaphragmatic hernia, megaesophagus How to cite this article: Prakash M, Ninan Z, Avirat V, Madhavan N, Mohammed JS. Megaesophagus in congenital diaphragmatic hernia. Indian J Surg 2005;67:327-9. Congenital diaphragmatic hernia (CDH) com- neonate immediately intubated and ventilated. His monly occurs through the posterolateral de- vital signs improved dramatically with positive pres- fect of Bochdalek and left sided hernias are sure ventilation and he received antibiotics, sedation, more common than right. The incidence and muscle paralysis and inotropes to stabilize his gener- variety of associated malformations are high- al condition. A plain radiograph of the chest and ab- ly variable and may be related to the side of domen revealed a left sided diaphragmatic hernia herniation. The association of CDH with meg- with the stomach and intestines located in the left aesophagus has been described earlier and hemithorax (Figure 1).
    [Show full text]
  • Pediatric Gastroesophageal Reflux Clinical Practice
    SOCIETY PAPER Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition ÃRachel Rosen, yYvan Vandenplas, zMaartje Singendonk, §Michael Cabana, jjCarlo DiLorenzo, ôFrederic Gottrand, #Sandeep Gupta, ÃÃMiranda Langendam, yyAnnamaria Staiano, zzNikhil Thapar, §§Neelesh Tipnis, and zMerit Tabbers ABSTRACT This document serves as an update of the North American Society for Pediatric INTRODUCTION Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European n 2009, the joint committee of the North American Society for Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Pediatric Gastroenterology, Hepatology, and Nutrition (NASP- 2009 clinical guidelines for the diagnosis and management of gastroesophageal GHAN)I and the European Society for Pediatric Gastroenterology, refluxdisease(GERD)ininfantsandchildrenandisintendedtobeappliedin Hepatology, and Nutrition (ESPGHAN) published a medical posi- daily practice and as a basis for clinical trials. Eight clinical questions addressing tion paper on gastroesophageal reflux (GER) and GER disease diagnostic, therapeutic and prognostic topics were formulated. A systematic (GERD) in infants and children (search until 2008), using the 2001 literature search was performed from October 1, 2008 (if the question was NASPGHAN guidelines as an outline (1). Recommendations were addressed
    [Show full text]
  • Abdominal Wall Defects—Current Treatments
    children Review Abdominal Wall Defects—Current Treatments Isabella N. Bielicki 1, Stig Somme 2, Giovanni Frongia 3, Stefan G. Holland-Cunz 1 and Raphael N. Vuille-dit-Bille 1,* 1 Department of Pediatric Surgery, University Children’s Hospital of Basel (UKBB), 4056 Basel, Switzerland; [email protected] (I.N.B.); [email protected] (S.G.H.-C.) 2 Department of Pediatric Surgery, University Children’s Hospital of Colorado, Aurora, CO 80045, USA; [email protected] 3 Section of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, 69120 Heidelberg, Germany; [email protected] * Correspondence: [email protected]; Tel.: +41-61-704-27-98 Abstract: Gastroschisis and omphalocele reflect the two most common abdominal wall defects in newborns. First postnatal care consists of defect coverage, avoidance of fluid and heat loss, fluid administration and gastric decompression. Definitive treatment is achieved by defect reduction and abdominal wall closure. Different techniques and timings are used depending on type and size of defect, the abdominal domain and comorbidities of the child. The present review aims to provide an overview of current treatments. Keywords: abdominal wall defect; gastroschisis; omphalocele; treatment 1. Gastroschisis Citation: Bielicki, I.N.; Somme, S.; 1.1. Introduction Frongia, G.; Holland-Cunz, S.G.; Gastroschisis is one of the most common congenital abdominal wall defects in new- Vuille-dit-Bille, R.N. Abdominal Wall borns. Children born with gastroschisis have a full-thickness paraumbilical abdominal Defects—Current Treatments. wall defect, which is associated with evisceration of bowel and sometimes other organs Children 2021, 8, 170.
    [Show full text]
  • Guideline for the Evaluation of Cholestatic Jaundice
    CLINICAL GUIDELINES Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition ÃRima Fawaz, yUlrich Baumann, zUdeme Ekong, §Bjo¨rn Fischler, jjNedim Hadzic, ôCara L. Mack, #Vale´rie A. McLin, ÃÃJean P. Molleston, yyEzequiel Neimark, zzVicky L. Ng, and §§Saul J. Karpen ABSTRACT Cholestatic jaundice in infancy affects approximately 1 in every 2500 term PREAMBLE infants and is infrequently recognized by primary providers in the setting of holestatic jaundice in infancy is an uncommon but poten- physiologic jaundice. Cholestatic jaundice is always pathologic and indicates tially serious problem that indicates hepatobiliary dysfunc- hepatobiliary dysfunction. Early detection by the primary care physician and tion.C Early detection of cholestatic jaundice by the primary care timely referrals to the pediatric gastroenterologist/hepatologist are important physician and timely, accurate diagnosis by the pediatric gastro- contributors to optimal treatment and prognosis. The most common causes of enterologist are important for successful treatment and an optimal cholestatic jaundice in the first months of life are biliary atresia (25%–40%) prognosis. The Cholestasis Guideline Committee consisted of 11 followed by an expanding list of monogenic disorders (25%), along with many members of 2 professional societies: the North American Society unknown or multifactorial (eg, parenteral nutrition-related) causes, each of for Gastroenterology, Hepatology and Nutrition, and the European which may have time-sensitive and distinct treatment plans. Thus, these Society for Gastroenterology, Hepatology and Nutrition. This guidelines can have an essential role for the evaluation of neonatal cholestasis committee has responded to a need in pediatrics and developed to optimize care.
    [Show full text]
  • Intestinal Malrotation: a Diagnosis to Consider in Acute Abdomen In
    Submitted on: 05/20/2018 Approved on: 08/07/2018 CASE REPORT Intestinal malrotation: a diagnosis to consider in acute abdomen in newborns Antônio Augusto de Andrade Cunha Filho1, Paula Aragão Coimbra2, Adriana Cartafina Perez-Bóscollo3, Robson Azevedo Dutra4, Katariny Parreira de Oliveira Alves5 Keywords: Abstract Intestinal obstruction, Intestinal malrotation is an anomaly of the midgut, resulting from an embryonic defect during the phases of herniation, Acute abdomen, rotation, and fixation. The objective is to report a case of complex diagnostics and approach. The diagnosis was made Gastrointestinal tract. surgically in a patient presenting with hemodynamic instability, abdominal distension, signs of intestinal obstruction, and pneumoperitoneum on abdominal X-ray, with suspected grade III necrotizing enterocolitis. During surgery, a volvulus resulting from poor intestinal rotation was found at a distance of 12 cm from the ileocecal valve. Hemodynamic instability and abdominal distension recurred, and another exploratory laparotomy was required to correct new intestinal perforations. Therefore, early diagnosis with surgical correction before a volvulus appears is essential. Abdominal Doppler ultrasonography has been promising for early diagnosis. 1 Academic in Medicine - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil 2 Resident in Pediatric Intensive Care - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil 3 Associate Professor - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil. 4 Adjunct Professor - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil 5 Academic in Medicine - Federal University of the Triângulo Mineiro - Uberaba - Minas Gerais - Brazil Correspondence to: Antônio Augusto de Andrade Cunha Filho. Universidade Federal do Triângulo Mineiro, Acadêmico de Medicina - Uberaba - Minas Gerais - Brasil.
    [Show full text]
  • Statistical Analysis Plan
    Cover Page for Statistical Analysis Plan Sponsor name: Novo Nordisk A/S NCT number NCT03061214 Sponsor trial ID: NN9535-4114 Official title of study: SUSTAINTM CHINA - Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Document date: 22 August 2019 Semaglutide s.c (Ozempic®) Date: 22 August 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL Clinical Trial Report Status: Final Appendix 16.1.9 16.1.9 Documentation of statistical methods List of contents Statistical analysis plan...................................................................................................................... /LQN Statistical documentation................................................................................................................... /LQN Redacted VWDWLVWLFDODQDO\VLVSODQ Includes redaction of personal identifiable information only. Statistical Analysis Plan Date: 28 May 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL UTN:U1111-1149-0432 Status: Final EudraCT No.:NA Page: 1 of 30 Statistical Analysis Plan Trial ID: NN9535-4114 Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Author Biostatistics Semaglutide s.c. This confidential document is the property of Novo Nordisk. No unpublished information contained herein may be disclosed without prior written approval from Novo Nordisk. Access to this document must be restricted to relevant parties.This
    [Show full text]
  • Appendix 3.1 Birth Defects Descriptions for NBDPN Core, Recommended, and Extended Conditions Updated March 2017
    Appendix 3.1 Birth Defects Descriptions for NBDPN Core, Recommended, and Extended Conditions Updated March 2017 Participating members of the Birth Defects Definitions Group: Lorenzo Botto (UT) John Carey (UT) Cynthia Cassell (CDC) Tiffany Colarusso (CDC) Janet Cragan (CDC) Marcia Feldkamp (UT) Jamie Frias (CDC) Angela Lin (MA) Cara Mai (CDC) Richard Olney (CDC) Carol Stanton (CO) Csaba Siffel (GA) Table of Contents LIST OF BIRTH DEFECTS ................................................................................................................................................. I DETAILED DESCRIPTIONS OF BIRTH DEFECTS ...................................................................................................... 1 FORMAT FOR BIRTH DEFECT DESCRIPTIONS ................................................................................................................................. 1 CENTRAL NERVOUS SYSTEM ....................................................................................................................................... 2 ANENCEPHALY ........................................................................................................................................................................ 2 ENCEPHALOCELE ..................................................................................................................................................................... 3 HOLOPROSENCEPHALY.............................................................................................................................................................
    [Show full text]
  • Duplication Cyst with Intestinal Volvulus Causing Intestinal Atresia/Stenosis in Neonates
    Journal of Neonatal Surgery 2018; 7:43 DOI: 10.21699/jns.v7i4.820. CASE SERIES Duplication Cyst with Intestinal Volvulus Causing Intestinal Atresia/Stenosis in Neonates Muhammad Bilal Mirza*, Imran Hashim, Shabbir Ahmad, Nabila Talat, M Zubair Shaukat, Muhammad Saleem Department of Pediatric Surgery, The Children’s Hospital and The Institute of Child Health, Lahore, Pakistan How to cite: Mirza B, Hashim I, Ahmad S, Talat N, Shaukat MZ, Saleem M. Duplication cyst with intestinal volvulus causing intestinal atresia/ stenosis in neonates. J Neonatal Surg. 2018; 7:43. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Duplication cysts of small bowel seldom present in newborns and usually represent the development of complications. In utero complications may lead to mesenteric vascular accidents and thus resulting in intestinal atresias. We report three neonates with duplication cyst of small bowel causing localized intestinal volvulus, leading to small bowel intestinal atresia/stenosis. The neonates underwent excision of the duplication cyst and resection anastomosis of the small bowel. Post-operative recovery was uneventful in all three of them. Key words: Atresia; Duplication cyst; Stenosis; Volvulus INTRODUCTION sound of abdomen showed dilated bowel loops. After adequate resuscitation, the patient was operated with Volvulus due to duplication cyst is a rare cause of suspicion of intestinal atresia. At surgery, a 3 cm × neonatal intestinal obstruction [1]. In utero volvulus 5 cm sized non-communicating cyst was encountered due to duplication cyst may also produce intestinal with 3–4 twists causing localized volvulus.
    [Show full text]
  • Congenital Pyloric Atresia: Clinical Features, Diagnosis, Associated Anomalies, Management and Outcome Osama A
    188 Original article Congenital pyloric atresia: clinical features, diagnosis, associated anomalies, management and outcome Osama A. Bawazira,b and Ahmed H. Al-Salemc Background Congenital pyloric atresia (CPA) is very rare period; however, 10 died later giving an overall survival of and usually seen as an isolated anomaly, which has an 40%. Sepsis was the main cause of death. excellent prognosis. CPA can be associated with other Conclusion CPA is a very rare malformation that can be anomalies or familial and these are usually associated with familial and inherited as an autosomal recessive. It can other hereditary conditions with poor prognosis. This either occur as an isolated lesion with an excellent review is based on our experience with 20 infants with CPA. prognosis, or be associated with other anomalies. Patients and methods This is a review of CPA, The overall prognosis of CPA, however, is still poor, and this highlighting its clinical features; associated anomalies; and is due to the frequent-and often fatal-associated aspects of diagnosis, management and outcome. anomalies. Ann Pediatr Surg 13:188–193 c 2017 Annals of Pediatric Surgery. Results This review is based on our experience with 20 patients with CPA (nine male and 11 female). Their mean Annals of Pediatric Surgery 2017, 13:188–193 birth weight was 2.1 kg (1.1-3.9 kg). Polyhydramnios was Keywords: aplasia cutis congenita, congenital pyloric atresia, seen in 13 (65%) patients. Seven patients were full-term epidermolysis bullosa, hereditary multiple intestinal atresia and the remaining 13 were premature. Two were brothers aDepartment of Surgery, Faculty of Medicine, Umm Al Qura University, Makkah, and four were members of the same family.
    [Show full text]
  • Nova Scotia Atlee Perinatal Database Coding Manual 15 Edition (Version
    Nova Scotia Atlee Perinatal Database Coding Manual 15th Edition (Version 15.0.0) April 2011 TABLE OF CONTENTS LISTINGS OF HOSPITALS 11 ADMISSION INFORMATION 16 DELIVERED ADMISSION 26 Routine Information – Delivered Admission 26 Routine Information – Labour 57 Routine Information – Infant 77 UNDELIVERED ADMISSION 94 Routine information – undelivered 94 POSTPARTUM ADMISSIONS 104 Routine Information – Postpartum Admission 104 NEONATAL ADMISSIONS 112 Routine Information – Neonatal Admissions 112 ADULT RCP CODES 124 INFANT RCP CODES 143 INDEX OF MATERNAL DISEASES AND PROCEDURES 179 INDEX OF NEONATAL DISEASES AND PROCEDURES 195 1 INDEX FOR ADMISSION INFORMATION Admission date .............................................................................................................................. 17 Admission time .............................................................................................................................. 17 Admission process status ............................................................................................................... 25 Admission type .............................................................................................................................. 17 A/S/D number ................................................................................................................................ 18 Birth date ....................................................................................................................................... 18 Care provider attending ................................................................................................................
    [Show full text]
  • The Gastrointestinal Tract Frank A
    91731_ch13 12/8/06 8:55 PM Page 549 13 The Gastrointestinal Tract Frank A. Mitros Emanuel Rubin THE ESOPHAGUS Bezoars Anatomy THE SMALL INTESTINE Congenital Disorders Anatomy Tracheoesophageal Fistula Congenital Disorders Rings and Webs Atresia and Stenosis Esophageal Diverticula Duplications (Enteric Cysts) Motor Disorders Meckel Diverticulum Achalasia Malrotation Scleroderma Meconium Ileus Hiatal Hernia Infections of the Small Intestine Esophagitis Bacterial Diarrhea Reflux Esophagitis Viral Gastroenteritis Barrett Esophagus Intestinal Tuberculosis Eosinophilic Esophagitis Intestinal Fungi Infective Esophagitis Parasites Chemical Esophagitis Vascular Diseases of the Small Intestine Esophagitis of Systemic Illness Acute Intestinal Ischemia Iatrogenic Cancer of Esophagitis Chronic Intestinal Ischemia Esophageal Varices Malabsorption Lacerations and Perforations Luminal-Phase Malabsorption Neoplasms of the Esophagus Intestinal-Phase Malabsorption Benign tumors Laboratory Evaluation Carcinoma Lactase Deficiency Adenocarcinoma Celiac Disease THE STOMACH Whipple Disease Anatomy AbetalipoproteinemiaHypogammaglobulinemia Congenital Disorders Congenital Lymphangiectasia Pyloric Stenosis Tropical Sprue Diaphragmatic Hernia Radiation Enteritis Rare Abnormalities Mechanical Obstruction Gastritis Neoplasms Acute Hemorrhagic Gastritis Benign Tumors Chronic Gastritis Malignant Tumors MénétrierDisease Pneumatosis Cystoides Intestinalis Peptic Ulcer Disease THE LARGE INTESTINE Benign Neoplasms Anatomy Stromal Tumors Congenital Disorders Epithelial Polyps
    [Show full text]
  • Duodenal Stenosis: a Diagnostic Challenge in a Neonate with Poor Weight Gain
    Open Access Case Report DOI: 10.7759/cureus.8559 Duodenal Stenosis: A Diagnostic Challenge in a Neonate With Poor Weight Gain Ma Khin Khin Win 1 , Carole Mensah 1 , Kunal Kaushik 1 , Louisdon Pierre 1 , Adebayo Adeyinka 1 1. Pediatrics, The Brooklyn Hospital Center, Brooklyn, USA Corresponding author: Carole Mensah, [email protected] Abstract Cases of isolated duodenal stenosis in the neonatal period are minimally reported in pediatric literature. Causes of small bowel obstruction such as duodenal atresia or malrotation with midgut volvulus have been well documented and are often diagnosed due to their acute clinical presentation. Duodenal stenosis, however, causes an incomplete intestinal obstruction with a more indolent and varying clinical presentation thus making it a diagnostic challenge. We present a neonate with a unique case of congenital duodenal stenosis. The neonate presented with poor weight gain and frequent "spit-ups" as per the mother at the initial newborn visit. The clinical presentation was masked as the patient was being fed infrequently and with concentrated formula. We postulate that this may be due to the fact that the mother was an adolescent and relatively inexperienced with newborn care. During the hospital course, the patient had recurrent episodes of emesis with notable electrolyte abnormalities including hypochloremia and metabolic alkalosis. Further investigation with an abdominal X-ray showed dilated loops of bowel. Pyloric stenosis was ruled out via abdominal ultrasound. An upper gastrointestinal (GI) series ultimately confirmed a diagnosis of duodenal stenosis and the infant underwent surgical repair with full recovery. Congenital duodenal stenosis may have atypical presentations in neonates requiring pediatricians to have a high index of suspicion for diagnosis and to ensure timely therapy.
    [Show full text]