WOFAPS 2025 8th World Congress of Pediatric Surgery

Senda Houidi, Fatma Thamri, Melek Mezni, Yasmine Karoui, Yosra Kerkeni, Riadh Jouini

children hospital Bechir Hamza, Pediatric surgery department A Tunis Tunisia

Introduction:

Bowel obstructions are one of the most common surgical emergencies in neonates, and it can be disastrous if left untreated. The underlying etiologies are varied, and surgical intervention is not always required. The aim of our study is to report all tips and tricks of this pathology.

Methods:

It was a retrospective study including 175 patients. The data were collected from the department of pediatric surgery in the Children’s Hospital of Tunis, from January 2019 to May 2024.

Results:

During the study period, 175 neonates were admitted for bowel obstruction. Among them, 78% presented with abdominal distension. The commonest causes of low bowel obstruction include anorectal malformations (11 cases), Hirschsprung's disease (HD; 26 cases), ileal atresia (8 cases), meconium ileus (10 cases), necrotizing enterocolitis (3 cases) and colonic atresia (1 patient). The commonest causes of high bowel obstruction: duodenal atresia/stenosis (6 cases), and malrotation with volvulus (4 cases), annular pancreas (2 cases).Surgical treatment was required in 64 cases (37%). The remaining patients had been managed medically for as hypothyroidism, electrolyte disturbances, dietary deviations, or meconium ileus. In two patients, HD was initially suspected due to delayed meconium passage. An upper gastrointestinal contrast study allowed the diagnosis of jejunal atresia in one case and incomplete duodenal atresia (diaphragm type) in the other. This imaging also led to the diagnosis and simultaneous management of a meconium ileus syndrome in another case. In the context of NIO, time is critical. Prompt intervention and accurate surgical decision-making are essential. While a simple dietary error may cause NIO, delayed management of Hirschsprung’s disease can be life-threatening without timely medical and surgical treatment. Follow-up ranged from 1 to 5 years. Evaluation focused on weight gain, digestive tolerance, and anal continence, particularly in patients with Hirschsprung’s disease and jejunal atresia. In cases of apple peel syndrome and short bowel syndrome, quality of life wasn’t good, with frequent gastrointestinal symptoms and ongoing electrolyte disturbances.

conclusion:

The imaging and decision-making steps allow for a rapid, simplified diagnosis that can benefit patients by recommending when to perform surgery avoiding any complication.