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Chronic bowel obstruction from colonic stenosis in early infancy-A report of two cases
Sebastian Okwuchukwu Ekenze1, Uchechukwu Obiora Ezomike1, Ijeoma Esther Nwachukwu1
1Sub-Department of Paediatric Surgery, College of Medicine, University of Nigeria.
Insights
Chronic colonic stenosis is a rare cause of bowel obstruction in infants. Early diagnosis requires a high index of suspicion for this condition in neonates presenting with chronic constipation and abdominal distension.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Bowel obstruction in infants often stems from congenital anomalies.
- Chronic colonic stenosis, however, is a rare but challenging diagnosis in this age group.
Observation:
- Two cases of male infants (9 and 11 weeks old) presented with massive abdominal distension and chronic bowel obstruction symptoms since the neonatal period.
- The first case had inconclusive investigations, leading to laparotomy which revealed isolated ascending colon stenosis.
- The second case, with suspected colonic stenosis, was diagnosed via barium enema showing multiple colonic stenoses.
Findings:
- Congenital or acquired colonic stenosis can present as chronic bowel obstruction in infancy.
- Diagnostic challenges exist, necessitating a high index of suspicion, especially in cases of chronic constipation.
- Barium enema can be a valuable tool in diagnosing colonic stenosis when suspected.
Implications:
- Increased awareness and a high index of suspicion are crucial for timely diagnosis of colonic stenosis in infants.
- Experience gained from challenging cases can improve diagnostic accuracy in subsequent similar presentations.
- Prompt diagnosis and management of colonic stenosis are vital to prevent complications associated with chronic bowel obstruction.
Abstract:
Bowel obstruction in early infancy may result from a variety of congenital anomalies involving parts of the small and large bowel. However, in infancy, chronic bowel obstructions from congenital or acquired stenosis of the colon are rare and can cause diagnostic quandary. We present two cases of an eleven-week old male and a nine-week old male with massive abdominal distension and features of chronic bowel obstruction dating from neonatal period. In the first case investigations were inconclusive and laparotomy revealed isolated stenosis of the ascending colon. In the second case colonic stenosis was suspected preoperatively and a barium enema done showed multiple colonic stenosis confirming our working diagnosis. The diagnostic dilemmas encountered in managing the first patient are discussed to highlight the need for high index of suspicion of this condition in infants with chronic constipation. The way experience in managing the first case influenced diagnosis of the second case is also highlighted.
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