Neonatal intestinal obstruction in Zaria, Nigeria

Objective: To study the aetiology, morbidity and mortality of neonatal intestinal obstruction.Design: A retrospective study.Setting: Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.Subjects: One hundred and fifty one neonates (£28 days) undergoing surgery for mechanical intestinal obstruction.Results: The male/female ratio was 3: 1 and median age at presentation was four days (range five hours - 28 days). Anorectal malformation was the commonest cause, 104 (68.9%), 86.5%of which were high anomalies and 13.5% low; the median age at presentation was three days. Fifty two per cent of colostomies for the high anomalies were performed using general anaesthesia and 48% local anaesthetic, but there was an increasing use of local anaesthesiaover the years. Hirschsprung’s disease accounted for 11(7.3%) of the cases, representing 20% of all patients presenting with Hirschsprung’s disease to this hospital; the median age was six days and in two patients the caecum and sigmoid colon respectively had perforated;nine patients had colostomy, one caecostomy and one ileostomy (total colonic aganglionosis). Eleven (7.3%) patients had incarcerated or strangulated ingunial hernia(ten) and congenital ventral hernia (one); the hernias were repaired in all patients and three required intestinalresection for gangrene, two of which had ipsilateral testicular gangrene, necessitating orchidectomy. Intestinal atresia was the fourth common cause of obstruction ten (6.7%), eight of which were jejunoileal atresias and two duodenal and the median age was seven days; one atresia was associated with Hirschsprung’s disease and had ileostomy, all otherjejunoileal atresias were resected and duodenoduodenostomy was performed for the duodenal atresias. Other less common causes of neonatal intestinal obstruction were incarcerated exomphalos, malrotation, hypertrophic pyloric stenosis, annular pancreas, and idiopathic ileal volvulus and meconium ileus respectively. Postoperative complications occurred in sixteen of 95 patients (16.8%) including colostomy or ileostomy complications 11, woundinfection three and anastomotic dehiscence(two). The overall mortality was 21.1 %, 70% from overwhelming infection and 30% respiratory embarrassment; the mortality from the various conditions were Hirschsprung’s disease 43%, intestinal atresia 40%, incarceratedexomphalos 40%, anorectal malformation 18.5% and the only patient with volvulus died.Conclusion: The morbidity and mortality of neonatal intestinal obstruction in this hospital has improved over previous years due largely to meticulous resuscitation before surgery but the problems of late presentation and poor neonatal intensive care facilities persist. Thefindings are at variance with those in developed countries