Investigations, management and outcome of neonates presenting with distal intestinal obstruction: challenging the need for contrast enemas
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In brief
In brief
This retrospective study of 124 term neonates with distal intestinal obstruction demonstrates that colonic irrigation should be first-line therapy, eliminating the need for contrast enema in most cases. All patients require suction rectal biopsy to rule out Hirschsprung disease, with CF testing indicated when meconium plugs are passed.
- Colonic irrigation should be first-line therapy for neonatal distal bowel obstruction, avoiding contrast enema in most cases.
- All neonates with distal obstruction require suction rectal biopsy to rule out Hirschsprung disease unless alternative diagnosis is clear.
- Meconium plug passage warrants cystic fibrosis testing, as CF was found in 3/19 meconium plug cases.
- Hirschsprung disease was the most common final diagnosis (54%), followed by meconium plug syndrome and intestinal atresia.
- Median neonatal unit stay was 11 days, reflecting the resource-intensive multimodal evaluation required for these patients.
Written by the GCMD Library team from the article.
Abstract
Purpose
To characterise the investigations, management and ultimate diagnosis of neonates with distal intestinal obstruction.
Methods
Retrospective review of term (> 37 weeks) neonates with admission diagnosis of distal intestinal obstruction over 10 years (2012–2022). Patient pathways were identified and associations between presentations, response to treatments and outcome investigated.
Results
A total of 124 neonates were identified and all included. Initial management was colonic irrigation in 108, contrast enema in 4, and laparotomy in 12. Of those responding to irrigations none underwent contrast enema. Ultimately, 22 neonates proceeded to laparotomy. Overall, 106 had a suction rectal biopsy and 41 had genetic testing for cystic fibrosis. Final diagnosis was Hirschsprung disease (HD) in 67, meconium ileus with cystic fibrosis (CF) in 9, meconium plug syndrome in 19 (including 3 with CF), intestinal atresia in 10 and no formal diagnosis in 17. Median length of neonatal unit stay was 11 days (7–19).
Conclusions
Initial management of neonates with distal bowel obstruction should be colonic irrigation since this is therapeutic in the majority and significantly reduces the need for contrast enema. These infants should all have suction rectal biopsy to investigate for HD unless another diagnosis is evident. If a meconium plug is passed, testing for CF is recommended. Evaluation and therapy are multimodal and time consuming, placing burden on resources and families.