Neonatal intestinal obstruction in a developing tropical country: patterns, problems, and prognosis

The experience with 211 cases of neonatal intestinal obstruction in Lagos, Nigeria, is described in an attempt to define the pattern in a developing country. Some of the major differences from the established pattern in the West include absence of meconium ileus and the relatively low prevalence of duodenal atresia which accounted for 8 per cent of bowel obstruction. Jejuno-ileal atresia and Hirschprung's disease constituted 21 and 14 per cent, respectively. Imperforate anus, as in the West, was the commonest, occurring in 38 per cent. Although neonatal intestinal obstruction was seen throughout the year a peak involving all the major types appeared in the second quarter. This may indicate an aetiological relationship with malaria. Delay in presentation, shortage of personnel, and inadequate facilities were the major problems associated with management of neonatal intestinal obstruction. The overall surgical mortality was 35 per cent; respiratory failure, metabolic disturbances, and malabsorption being the major causes of death.