Ameh E A, Chirdan L B
Paediatric Surgery Unit, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
East Afr Med J. 2000 Sep;77(9):510-3. doi: 10.4314/eamj.v77i9.46702.
To study the aetiology, morbidity and mortality of neonatal intestinal obstruction.
A retrospective study.
Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
One hundred and fifty one neonates (< or = 28 days) undergoing surgery for mechanical intestinal obstruction.
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 anaesthesia over 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 intestinal resection 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 other jejunoileal 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, wound infection 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%, incarcerated exomphalos 40%, anorectal malformation 18.5% and the only patient with volvulus died.
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. The findings are at variance with those in developed countries.
研究新生儿肠梗阻的病因、发病率及死亡率。
一项回顾性研究。
尼日利亚扎里亚市阿哈马杜·贝洛大学教学医院。
151例接受机械性肠梗阻手术的新生儿（年龄≤28天）。
男女比例为3:1，就诊时的中位年龄为4天（范围为5小时至28天）。肛门直肠畸形是最常见的病因，共104例（68.9%），其中86.5%为高位畸形，13.5%为低位畸形；就诊时的中位年龄为3天。高位畸形行结肠造口术的患儿中，52%采用全身麻醉，48%采用局部麻醉，但近年来局部麻醉的使用有所增加。先天性巨结肠病占11例（7.3%），占本院所有先天性巨结肠病患儿的20%；中位年龄为6天，2例患儿分别出现盲肠和乙状结肠穿孔；9例行结肠造口术，1例行盲肠造口术，1例行回肠造口术（全结肠无神经节细胞症）。11例（7.3%）患儿发生嵌顿性或绞窄性腹股沟疝（10例）及先天性腹疝（1例）；所有患儿均行疝修补术，3例因肠坏疽需行肠切除，其中2例同侧睾丸坏疽，需行睾丸切除术。肠闭锁是第四常见的梗阻原因，共10例（6.7%），其中8例为空肠回肠闭锁，2例为十二指肠闭锁，中位年龄为7天；1例闭锁合并先天性巨结肠病，行回肠造口术，其他所有空肠回肠闭锁均行切除术，十二指肠闭锁则行十二指肠十二指肠吻合术。新生儿肠梗阻的其他少见病因分别为嵌顿性脐膨出、肠旋转不良、肥厚性幽门狭窄、环状胰腺、特发性回肠扭转及胎粪性肠梗阻。95例患儿中有16例（16.8%）发生术后并发症，包括结肠造口术或回肠造口术并发症11例、伤口感染3例及吻合口裂开2例。总体死亡率为21.1%，70%死于严重感染，30%死于呼吸窘迫；各种病因的死亡率分别为：先天性巨结肠病43%、肠闭锁40%、嵌顿性脐膨出40%、肛门直肠畸形18.5%，唯一1例肠扭转患儿死亡。
本院新生儿肠梗阻的发病率及死亡率较前几年有所改善，这主要归功于手术前精心的复苏措施，但就诊延迟及新生儿重症监护设施不完善的问题依然存在。这些研究结果与发达国家的情况不同。
