Segmental dilatation of the intestine – case series of newborns with segmental dilatation of the small intestine and a literature review

Česká verzia

Authors: K. Hanousková ¹; A. Matějková ²; M. Navratilova ¹; T. Matějek ¹; J. Koudelka ³; P. Rejtar ⁴; Z. Kokštein ¹; J. Malý ¹
Authors place of work: Dětská klinika LF UK a FN, Hradec Králové přednosta prof. MUDr. M. Bayer, CSc. ¹; Fingerlandův ústav patologie LF UK a FN, Hradec Králové přednosta prof. MUDr. A. Ryška, Ph. D. ²; Oddělení dětské chirurgie a traumatologie FN, Hradec Králové primář MUDr. J. Koudelka, CSc. ³; Radiologická klinika LF UK a FN, Hradec Králové přednosta prof. MUDr. A. Krajina, CSc. ⁴
Published in the journal: Čes-slov Pediat 2015; 70 (3): 135-145.
Category: Original Papers

Summary

Introduction:
Segmental dilatation of the intestine (SDI) is a rarely published disorder characterized by abnormal dilatation of one or more intestinal segments of normal diameter and transit both orally and aborally manifesting by functional obstruction of the intestines. Every part of small or large intestine can be affected, most frequently ileum. Resection of affected segment is curative in the majority of cases. Normal intestinal wall including ganglion cells is the most common histological finding; abnormally thin muscle layer or hypertrophy were described in the other cases.

Objectives:
The aim of this work is a case series presentation, a review of available literature and a formulation of questions concerning SDI classification.

Methods:
The retrospective case series study of patients treated at the Department of Pediatrics of University Hospital in Hradec Králové. The information was retrieved from medical records. Results: SDI was diagnosed in 22 patients. All patiens were premature newborns; 19 (86%) of birth weight <1500 g, 15 of them (68% of all cases) of birth weight <1000 g. The median birth weigth was 815 g (680–2720 g), the median gestational age was 26 weeks (24–35 weeks). SDI was slightly more frequently diagnosed in male newborns (male-to-female ratio – 13:9; i.e. 1.4:1). Clinical manifestations including abdominal distension, prominent bowel loops and feeding intolerance occured between day 1–14 of life (on the 5th day on average). Ileum was affected in 21 (95%) patients, part of jejunum was simultaneously dilated in two cases; jejunum exclusively was affected in one case (5%). Resection of dilated segment with following primary anastomosis or creating a stoma was performed in all 21 (95%) operated patiens. Defect of intestinal muscle layer in dilated segment was found in 11 (50%) patients. Prognosis was influenced mostly by general medical condition and prematurity associated diseases. The incidence of SDI was 1.4 cases to 10,000 lifeborn infants in the catchment area of Eastern Bohemia at the given time period.

Conclusions:
SDI is probably heterogeneous nosologic unit including more similar conditions of different origin. We presume possible diagnoses overlapping between SDI and segmental defect/absence of the intestinal musculature.

Key words:
segmental dilatation of the intestine, newborn, small intestine, intestinal muscle layer defect M.

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