Journal of Neonatal Surgery

Constrained evidence-based practice

Laraib Amjad Dudrah, Muhammad Bilal Mirza — Tue, 03 Jan 2023 00:00:00 -0500

Short Bowel Syndrome in neonates and early infancy

Shivani Dogra, Nitin James Peters, Ram Samujh — Sat, 14 Jan 2023 00:00:00 -0500

Short bowel syndrome (SBS) is the commonest cause of intestinal failure in neonates. SBS results from widespread damage to the small intestine, leading to loss of functional capacity of this organ. This is generally secondary to conditions like necrotizing enterocolitis, gastroschisis, intestinal atresia, and midgut volvulus. The small bowel usually adapts to this damage in due course of time. The clinician's role usually entails the management of parenteral nutrition and the fluid and electrolyte balance to tide over this phase. The management should be initiated as soon as the diagnosis is suspected, especially post-surgical resection of the bowel. This should comprise enteral nutrition, with proactive monitoring and supplementation of electrolytes and micronutrients. Intestinal lengthening procedures like the Serial transverse enteroplasty (STEP), and Longitudinal intestinal lengthening and tailoring (LILT) may be considered in infants, where medical therapy fails to correct the pathology. The intricate nature of the condition warrants a multi-disciplinary approach, involving clinicians, intensivists, and surgeons, which ensures the best neonatal outcomes, in terms of the survival rates in these babies.

Spontaneous perforation of Meckel's diverticulum causing a partial small bowel obstruction: A case report

Mon, 09 Jan 2023 00:00:00 -0500

Background: Meckel's diverticulum is a common congenital malformation in young children. Perforation of Meckel's diverticulum in a neonate is a rarity and poses diagnostic and management challenges.

Case Presentation: This patient is a former 26 5/7 week estimated gestational age infant who presented at 41 weeks corrected gestational age with abdominal distension and was discovered to have a perforated Meckel's diverticulum that presented as a partial small bowel obstruction. Resection of the involved bowel and ileo-ileal anastomosis was performed.

Conclusion: Small bowel obstructions should be considered as a potential presentation of a perforated Meckel's diverticulum.

Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report

Heerani Woodun, Jeremy Thomas, Dushyant Batra, Nia Fraser — Tue, 10 Jan 2023 00:00:00 -0500

Background: Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birth weight, low APGAR scores, and cesarean-section delivery.

Case Presentation: A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment cesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apneic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high-frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day 10, gradual removal of five chest drains by day 19, and extubation on day 24. Transillumination and chest radiography were the main diagnostic investigations. Laryngotracheobronchoscopy on day 16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis, and pulmonary hypertension and was discharged home on day 66.

Conclusion: Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Management is patient-specific and includes needle and tube thoracocentesis and often, mechanical ventilation. Our case demonstrates the challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum.

Two-stage surgical management of horseshoe lung associated with congenital pulmonary airway malformation in a neonate: A case report

Fri, 21 Apr 2023 00:00:00 -0400

Background: Horseshoe lung is a rare congenital malformation, and even rarer is its association with congenital pulmonary airway malformations.

Case Presentation: We report a case of horseshoe lung associated with congenital pulmonary airway malformation (Stocker type 2) who underwent surgical management in two stages. The patient had a right posterolateral thoracotomy with lower right lobectomy at 14 days of life, followed by a left posterolateral thoracotomy with lower left lobectomy at 7 months of age. He is doing fine after both surgeries and follow-up visits are ongoing.

Conclusion: The treatment of horseshoe lung should be individualized, surgical management is an effective option and the two-stage approach in neonates would reduce the risk of the simultaneous bilateral procedure.

Choledochal cyst presenting with neonatal intestinal obstruction: A case report

IGB Adria Hariastawa, Yoshua Eric Irawan, Illona Okvita Wiyogo — Sun, 09 Jul 2023 00:00:00 -0400

Background: Most patients with choledochal cysts are diagnosed during childhood. Therefore, the aim of this study is to report a case of early detected choledochal cyst in a neonate patient presenting with intestinal obstruction.

Case Presentation: A 5-day-old baby girl was brought to the hospital with a chief complaint of bilious vomiting. No history of jaundice was found. Ultrasound in the third trimester (37 weeks) showed an anechoic cyst with a smooth wall, no septum, with a size of 5.5x4.7x4.7 cm, suspected ovarian cyst. At 4 days old, MRCP showed dilated right and left Intrahepatic bile duct with a normal gallbladder, suspected as choledochal cyst Todani type 1. The patient was operated on at 7 days old and was discharged 15 days after surgery. Nine months after discharge, the patient was in good condition with no complaints of jaundice nor acholic stool and normal liver function test.

Conclusion: Prenatal diagnosis of choledochal cyst gave awareness to receive appropriate treatment. Bowel obstruction without jaundice could be an early symptom of a choledochal cyst in neonates.

Giant segmental dilatation of jejunum causing volvulus in an infant: A case report

Fri, 21 Jul 2023 00:00:00 -0400

Background: Giant segmental dilatation of jejunum (SDJ) is rare in small infants where it often presents with intestinal obstruction. Occasionally, the giant SDJ may twist resulting in volvulus.

Case Presentation: A 1-month-old female infant presented with intestinal obstruction. At surgery, isolated giant segmental dilatation of the jejunum causing volvulus of the bowel was found. The gut was viable. The SDJ was excised and jejuno-jejunal anastomosis was performed. Ladd’s procedure was also performed for the associated malrotation. Postoperative recovery remained uneventful.

Conclusion: Giant SDJ is a rare entity, rarer still is its presentation with volvulus secondary to its twist. Early diagnosis and prompt management result in a good outcome.

Gastric pneumatosis in a preterm infant: A case report

Mon, 28 Aug 2023 00:00:00 -0400

Background: Gastric pneumatosis is a rare condition characterized by the presence of intramural gas in the stomach wall. It is uncommon in infants and is usually caused by proximal intestinal obstruction or necrotizing enterocolitis, a serious condition typically seen in preterm babies.

Case Presentation: An extremely preterm baby born at 23 weeks of gestation weighing 640 grams, with bronchopulmonary dysplasia and other comorbidities like patent ductus arteriosus, staph aureus sepsis, developed abdominal distension and non-bilious vomiting at 4 months of age. X-ray abdomen revealed gastric pneumatosis. The condition was managed with conservative measures.

Conclusion: Gastric pneumatosis secondary to necrotizing enterocolitis is uncommon in infants and needs prompt evaluation and management to prevent further deterioration.

Duodenal atresia, annular pancreas, and situs inversus totalis- rare association in a newborn: A case report

Tue, 05 Sep 2023 00:00:00 -0400

Background: Simultaneous occurrence of duodenal atresia, annular pancreas, and situs inversus totalis is an exceedingly rare clinical condition. This may pose management-related challenges to the treating surgeon.

Case Presentation: We report a case with a preoperative diagnosis of duodenal atresia and situs inversus. Intraoperatively, an annular pancreas encircling the duodenum was found. Instead of duodenoduodenostomy, a duodenojejunal anastomosis was performed. The postoperative course remained uneventful. The patient is doing fine on a 6-month follow-up.

Conclusion: The simultaneous presence of multiple anomalies in this patient prompted us to utilize an alternative approach to relieve the duodenal obstruction. This report highlights the importance of tailoring surgical decisions based on the individualized needs of the patient.

Oropharyngeal teratoma in a newborn: A case report

Dania Bouguermouh, Said Boutemeur , Fatma Hamel — Tue, 05 Dec 2023 00:00:00 -0500

Background: Facial teratomas are rare congenital tumors in the craniocervical region. They constitute only 2-5% of all childhood teratomas.

Case Presentation: This report presents a case of an oral teratoma in an infant, attached to the palate and extending sublingually on the right side, along with a cleft palate. The patient underwent successful surgical excision on the 17th day of life performed by a team of pediatric and maxillofacial surgeons.

Conclusion: The case emphasizes the importance of interdisciplinary coordination for the management of facial teratomas, involving maxillofacial and pediatric surgeons, neonatologists, anesthesiologists, and obstetrics specialists.

Triple atresia: Staged repair

Meryem Unal, Muhammad Fadli Abdullah, Hazlina Mohd Khalid, Mughni Bahari — Tue, 03 Jan 2023 00:00:00 -0500

Poor outcomes in congenital short bowel syndrome with intestinal malrotation: Experience from a developing country

Tue, 04 Apr 2023 00:00:00 -0400

Re: Constrained evidence-based practice

Amit Trivedi, Nadia Badawi, Gordon Thomas — Tue, 25 Apr 2023 00:00:00 -0400

Rapidly growing ranula and its management in a neonate

Tue, 15 Aug 2023 00:00:00 -0400

Algorithm for failure to pass meconium since birth in neonates

Muhammad Zaeem Khalid, Jamal Yousaf, Muhammad Hanzlah Shabbir — Sun, 22 Oct 2023 00:00:00 -0400

Giant axillary macrocystic lymphatic malformation in a newborn

Chipo-Tinomuda Nyamukapa, David Msuya, Alex Mremi, Abbas Mohamedali, Jay Lodhia — Wed, 04 Oct 2023 00:00:00 -0400

Intrauterine toes gangrene in a neonate

Fariba Hemmati, Hamide Barzegar — Sun, 14 May 2023 00:00:00 -0400

Nucleated red blood cells as a potential biomarker for predicting spontaneous intestinal perforation in premature infants

Tue, 31 Jan 2023 00:00:00 -0500

Background: The specific etiology of spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC) remains elusive. Both can present acutely without antecedent signs and can be difficult to differentiate. Neonatal nucleated red blood cell (NRBC) counts are part of the routine admission and serial CBCs drawn on premature neonates. Elevated NRBC counts could represent relative intrauterine hypoxemia, a possible risk factor for the development of SIP or NEC.

Methods: We compared premature neonates with SIP to premature neonates with NEC and controls, matched gestational age (GA) and birth weight (BW). Kruskal-Wallis, Chi-Square, or Fisher's exact tests and univariate and multivariate nominal logistic regression models were used to estimate the association of baseline NRBC. Median times to SIP and NEC were calculated using the Kaplan-Meier method. All analyses were performed with SAS 9.4.

Results: Male sex (72.5%), lower GA [Median (Q1, Q3): 25.1 (23.8, 28)], and lower BW [Median (Q1, Q3): 690 g (585, 1072)] had the highest incidence of SIP compared to NEC or controls. Increased baseline NRBC was associated with lower odds of developing NEC compared to controls [Median (Q1, Q3): 9 (5, 29) vs 19 (10, 51); OR (CI) 0.70 (0.55, 0.89), p-value = 0.0033]. Increased baseline NRBC was associated with higher odds of developing SIP compared to NEC [Median (Q1, Q3): 9 (5, 29) vs 19 (10, 51); OR (CI) 1.61 (1.18, 2.20) p-value = 0.0027]. There were no significant differences between intrauterine growth restriction (IUGR), maternal hypertension, chorioamnionitis, multiple births, or depressed APGAR scores in all three groups. NRBC for SIP neonates remained significantly higher at the day of life (DOL) 1-3 compared to other groups [Median (Q1, Q3): 23 (6, 93), p-value = 0.0020]. The percentage of patients with NRBC >4, remained elevated for patients with SIP as late as week three (p = 0.0023).

Conclusion: ELBW, male sex, and elevated baseline NRBC were significantly associated with the risk of developing SIP compared to NEC or controls. NRBC remained significantly elevated on DOL 1-3, compared to NEC or controls. Between the groups, there were no significant differences in perinatal stressors.

Factors associated with cholestasis after surgery for congenital duodenal atresia

Yosuke Minami, Kazuaki Takiguchi, Hirofumi Shimizu, Hideaki Tanaka — Thu, 23 Mar 2023 00:00:00 -0400

Background: This study assessed the characteristics of neonates with duodenal atresia (DA) who developed transient postoperative cholestasis which resolved spontaneously, without identifiable congenital anomalies or surgical complications, and identified potential risk factors for cholestasis.

Methods: Neonates with DA who underwent surgery at our institution between January 2009 and July 2022 were retrospectively reviewed. Demographic factors, intraoperative findings, placement of a trans-anastomotic tube (TAT), and postoperative outcomes were compared between patients who developed cholestasis (conjugated hyperbilirubinemia >2.0 mg/dL) after surgery (Group A) and those who did not (Group B). This report is a retrospective cohort study and complies with the STROBE statement.

Results: Among 19 neonates with DA, 6 (31.6%) developed cholestasis after surgery, with the highest direct bilirubin value being 4.3 (2.4-6.5) mg/dL (median, [range]) on postoperative day 14.5 (2-23) that persisted for 67 (47-116) days until spontaneous resolution. Neonates in Group A had a significantly younger gestational age (36.6 vs. 38.0 weeks) (median) (p=0.038), a higher rate of Down syndrome (66.7 vs. 15.4%) (p=0.046), a higher rate of TAT placement (66.7 vs. 15.4%) (p=0.046), and longer administration of total parenteral nutrition (15.5 vs. 7.0 days) (p=0.027) than those in Group B.

Conclusion: Transient cholestasis after surgery for DA seemed to be associated with prematurity, Down syndrome, parenteral nutrition, and TAT placement.

Epidemiology of congenital diaphragmatic hernia, esophageal atresia, and gastroschisis in South Brazil

Wed, 12 Apr 2023 00:00:00 -0400

Background: Birth defects remain a major contributor to infant mortality and lifelong disabilities. The epidemiology of congenital abnormalities varies around the world and little information is available from Latin America.

Methods: This is an epidemiological, descriptive, cross-sectional study with data from the Department of Informatics of the Unified Health System (DATASUS) on Congenital diaphragmatic hernia (CDH), esophageal atresia (EA) and gastroschisis (GS) in South Brazil from 2009 to 2019.

Results: The incidence of CDH is 0.93 cases, while EA is 0.47 and GS is 2.87, all per 10,000 live births. There is an association between all the malformations and premature birth, cesarean delivery, low birth weight, and low Apgar scores. Both EA and GS are associated with maternal age, EA with older, and GS with younger mothers. While EA is associated with multiple pregnancies, GS is associated with fewer years of maternal formal education, single parenting, and a lower number of prenatal consultations. CDH is associated with the male sex and black ethnicity.

Conclusion: This large population-based study estimates the prevalence and demographic factors associated with CDH, EA, and GS, and extends the limited descriptive epidemiologic information available.

Early outcome analysis of Gastroschisis from a high-volume tertiary care institute in India: A prospective observational study

Rahul Gupta, Bhairu Lal Gurjar — Tue, 04 Jul 2023 00:00:00 -0400

Background: Gastroschisis is one of the common congenital anterior abdominal wall defects with uncovered abdominal contents (usually intestines) protruding through it. Immediate reduction of the abdominal contents is crucial after birth because of the grave consequences of delayed management. The aim of our study was to evaluate the early outcomes of Gastroschisis at a tertiary care institute in India.

Methods: This prospective observational study was undertaken over a one-year duration extending from January to December 2021 at our pediatric tertiary care teaching institute.

Results: There were 30 male and 28 female patients, out of which 37 were preterm neonates. The mean birth weight was 2019?357g. Seven patients (12.07%) had major associated malformations. Fifty (86.21%) patients underwent primary skin flap closure. Staged reduction with silo was accomplished in five (8.62%) patients; three patients died during resuscitation before any therapeutic procedure could be undertaken. Among 55 (94.83%) patients with surgical procedures, only 26 (47.27%) could be salvaged with overall favorable (survival) outcomes in 44.83% of patients. Mortality was high (92.59%, 25/27) in the patients presenting with markedly edematous bowel with leathery peel.? Seventeen (29.31%, 17/58) neonates died in the first 72 hours (postoperatively) due to complications of abdominal compartment syndrome, eight (13.79%) patients died due to postoperative sepsis with thrombocytopenia, and two (3.44%) had intestinal perforation. The duration of hospital stay in neonates who survived ranged from one to four weeks.

Conclusion: Overall survival rates in our study were 44.83% markedly in contrast to the series published in the recent literature. The outcome of preterm (premature) patients, associated intestinal atresia, presence of edematous bowel with leathery peel, patients requiring silo due to viscero-abdominal disproportion, necrotizing enterocolitis, and associated malformations, was dismal.

Transanal pull-through for Hirschsprung disease in neonates: A single-center experience

Tue, 14 Nov 2023 00:00:00 -0500

Background: Transanal pull-through for the treatment of Hirschsprung disease in the neonatal period remains debatable. This study reported our experience with transanal pull-through in neonates.

Methods: We reviewed medical records of neonates with Hirschsprung disease treated in our department with transanal pull-through between the years 2010 and 2016.

Results: Of the 40 included patients, 31 were male neonates, and 9 were female. The mean age at the time of surgery was 13 days. The mean operative time was 136 minutes. The level of aganglionosis was rectal in 8 cases, rectosigmoid in 19 cases, descending colon in 7 cases, splenic flexure in 3 cases, transverse colon in 2 cases, and ascending colon in one case. A combined abdominal approach was used in 11 patients. There were no intraoperative complications. Major complications were noted in 4 cases: anastomotic leakage in 3 cases of whom one succumbed 3 days postoperatively; and bowel perforation in one case. The most common late postoperative complication was fecal soiling encountered in 25% of cases. Two among 29 patients who reached the age of continence remain incontinent.

Conclusion: Transanal pull-through in neonates has similar outcomes and complications to those of infants and children. Therefore this procedure can be safely employed in neonates however we recommend that the treating team should have an ample learning curve for this procedure in infants.

Improvement of Broviac catheter-related outcomes after the implementation of a quality management system: A before-and-after prospective observational study

Manel Kammoun, Anouar Jarraya, Saloua Ammar, kamel Kolsi — Tue, 03 Jan 2023 00:00:00 -0500

Background: Because of the high rates of Broviac catheter complications, we started an urgent quality process to reduce this morbidity. The aim is to assess the efficiency of the main actions we have taken in enhancing our practice and improving Broviac outcomes.

Methods: We included all neonates and young infants requiring surgical central venous access using a Broviac tunneled catheter. We compared the catheters’ outcomes before and after the implementation of a quality program based on a nurse teaching program, patient selection, and catheter management multidisciplinary protocol. The significance threshold was set at p<0.05.

Results: We included 94 patients: 51 in the protocol group and 43 in the control group. The complication rate was reduced from 60.3% to 25.5% with p=0.001. The lifetime of the catheter was improved from 11.3 ± 4.3 days to 19.1 ± 9 days with p=0.007. The catheter infection was reduced from 65.3% to 46.1% with p≤0.001.

Conclusion: This quality improvement project shows the utility of a quality assurance program based on careful indications and patient selection, a nursing teaching program, and a multidisciplinary catheter management protocol, in reducing Broviac catheter-related morbidity.

Fetal Lung Interstitial Tumor (FLIT): A case series

Tue, 03 Jan 2023 00:00:00 -0500

Background: Fetal Lung Interstitial Tumor (FLIT) is a rare benign lung tumor. There have been 18 cases of FLIT described in the literature. FLIT is characterized by a region of arrested lung development and must be differentiated from other congenital lung lesions with poorer prognoses.

Case Presentation: We report the first two known cases of FLIT in Australia and New Zealand. In both cases, the patients developed respiratory distress at birth requiring intubation. Imaging revealed solid lesions and echocardiography demonstrated pulmonary hypertension. The patients underwent surgical resection without any complications or recurrence.

Conclusion: FLIT is a rare benign congenital lung tumor that can be adequately managed with surgical resection.

Experience with endoluminal vacuum therapy in the management of esophageal anastomotic leakage in newborns with esophageal atresia: A case series

Fri, 03 Mar 2023 00:00:00 -0500

Background: The management of dehiscence of esophageal anastomosis is challenging and requires a multidisciplinary approach. Endoluminal vacuum therapy (EVT) has shown promising results.

Case Presentation: Herein we present the data of two cases with esophageal atresia who developed esophageal anastomotic leakage, during 2021-2022, and who underwent EVT. The first case had 60% dehiscence of the anastomosis, anastomotic leak repair was performed followed by esophageal EVT placement. In the second case, the dehiscence was limited to 10%, and only esophageal EVT was provided. Within four and six days of EVT, upper gastrointestinal endoscopy and fluoroscopy were performed which showed tissue proliferation in situ and the absence of contrast leakage. Both patients were able to resume oral tolerance on the 4th day.

Conclusion: Esophageal EVT has shown promising results in the management of esophageal anastomotic leakage in newborns with esophageal atresia.

Management of persistent air leak in Neonates: A case series

Sun, 28 May 2023 00:00:00 -0400

Background: Autologous blood patch pleurodesis (ABPP) has been used in adults as an efficient and safe technique to address persistent air leak (PAL). A fibrin glue patch is also an alternative, but its elevated cost and technique can limit its routine use. Evidence of their use in the pediatric population, specifically in the neonatal age is scant.

Case Presentation: We share our management experience in a series of 3 cases. The first 2 were treated exclusively with ABPP and showed clinical and radiographic improvement. The 3rd case, due to the persistence of the air leak, required extended thoracotomy and fibrin patch placement.

Conclusion: The use of ABPP as an alternative for the treatment of neonates with PAL is a safe and efficient technique. The procedure is replicable and can be done at the bedside at a low cost. A fibrin glue patch should be considered as an alternative option when ABPP fails to resolve the leak.

Iatrogenic esophageal perforation in infants: How to avoid thoracotomy? A case series

Riccardo Rizzo, Filomena Valentina Paradiso, Sara Silvaroli, Lorenzo Nanni — Fri, 09 Jun 2023 00:00:00 -0400

Background: Esophageal perforation is uncommon and often iatrogenic in the neonatal period, with premature and low birth weight infants (<1500 g) being particularly susceptible. It usually occurs at the pharyngoesophageal junction and can be confused with esophageal atresia due to respiratory signs and excessive salivation. Diagnostic evaluation and treatment are still debated.

Case Presentation: Two neonatal cases of iatrogenic esophageal perforation are described. The suspected diagnosis was confirmed only with thoracotomy. Diagnostic difficulties and therapeutic modalities are discussed.

Conclusion: These two cases show the importance of the clinical clues (anamnesis and clinical findings) to suspect the diagnosis of esophageal perforation.

Neonatal osteomyelitis: A case series

Parveen Kumar, Ankur Bhardwaj, Anil Agarwal, Divyamedha Agarwal — Wed, 26 Jul 2023 00:00:00 -0400

Background: Osteomyelitis in the neonatal age group is a rare entity. Its presentation and progression are quite different from osteomyelitis in adults, adolescents, and even children. Due to vague clinical features and the late appearance of changes on X-rays, the diagnosis often gets missed. Additionally, there is a risk of permanent damage to bones and joints.

Case Presentation: Our experience of 3 such interesting cases showed the diagnostic dilemma involved in neonatal osteomyelitis. All 3 cases presented as cellulitis or subcutaneous abscess initially as x-ray changes appeared late (7-10 days after onset of disease). All the babies needed surgical debridement. The average duration of antibiotics given was 35.5 days. No residual sequelae were reported for up to 2 years.

Conclusion: Neonatal osteomyelitis needs a high index of suspicion especially in late-onset neonatal sepsis or prolonged septicemia. This case series emphasizes the need for a low threshold for suspicion and early treatment to avoid permanent disability.

Extrathoracic esophageal elongation with Foker technique in patients with Type-A esophageal atresia. A case series

Wed, 06 Sep 2023 00:00:00 -0400

Background: Long-gap esophageal atresia (EA) is not amenable to primary anastomosis though the goal of surgical treatment is to restore the patency in the native esophagus; the Foker technique is one of the methods that can accomplish it.

Case Presentation: This case series consists of three patients who presented with a type-A long-gap EA. Extrathoracic esophageal elongation was achieved using the Foker technique. During the first stage, we utilized pledgeted sutures reinforced with titanium clips for elongation that began five days after the surgery. As the elongation progressed, and the gap between esophageal pouches decreased, we restored the continuity of the esophagus. On follow-up, all patients needed pneumatic dilatation of the esophagus.

Conclusion: The Foker technique successfully restored the esophageal continuity using the native esophagus in our patients with esophageal atresia.

Neonatal gastric perforation in Twins: Two distinct cases

Thu, 30 Nov 2023 00:00:00 -0500

Background: Neonatal gastric perforation (NGP) is an uncommon but fatal condition. The exact cause of NGP remains unclear, although some cases have been linked to medical interventions. NGP is rarely reported in twins.

Case Presentation: Herein we report two cases of gastric perforation in twins. The first baby was one of the 34-week preterm twins that developed abdominal distension and respiratory distress on the third day of life. While the other baby was one of the 32-week preterm twins that too developed abdominal distension and respiratory distress. Both had gastric perforations that needed surgical repair. One baby died of sepsis while the other neonate had a stormy postoperative course, which was managed with meticulous monitoring and multidisciplinary management, and discharged in good clinical condition.

Conclusion: Clinical cases demonstrate that successful management of NGP requires a multidisciplinary approach, including timely surgical intervention, meticulous postoperative care, and close monitoring of complications.

A case of Aphallia associated with neonatal intestinal obstruction

Omar Ajaj — Fri, 06 Jan 2023 00:00:00 -0500