Chronic bowel obstruction from colonic stenosis in early infancy-A report of two cases

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.

Figure 1

Supine view, plain abdominal radiograph showing markedly dilated bowel loops

Figure 2

Intra-operative picture showing stenosed ascending colon (left arrowe), dilated caecum and distal ileum(right arrow)

Figure 3

Barium enema showing multiple colonic stenosis in case report 2

Figure 4

The segment of resected stenosed ascending, transverse and descending colon

Figure 5

The segment of resected stenosed ascending, transverse and descending colon