Postoperative Ileocolic Intussusception in a Neonate with Anorectal Malformation

Abstract

A 7-days-old male neonate with anorectal malformation (ARM) presented with abdominal distension and bleeding per rectum. He had an operation for ARM (Anoplasty) a day after birth and the patient had history of passing stool normally for two days. It was followed by blood mixed stool and abdominal distension. On examination, the patient had features of mild dehydration and sepsis. The abdomen was distended and a mass was palpable on left side of abdomen. Perineal examination showed attempt of a primary anoplasty performed at other hospital for absent anal opening to decompress the bowel. Haematological and biochemical investigations including coagulation profile were in the normal limits. X-ray abdomen in AP erect view revealed multiple air fluid levels. Patient was resuscitated with intravenous (IV) fluids. Antibiotics and analgesics were started. In view of abdominal distension, palpable abdominal mass, and history of bloody stool, we kept the possibility of intussusception in mind. Exploratory laparotomy was performed after about four hours of admission. Intraoperatively, ileocolic intussusception was found, which was advancing up to the sigmoid colon (Fig.1). It was not possible to manually reduce the intussusception owing to ischemic intussusceptum, thus resection of bowel with ileostomy and colonic mucous fistula (Transverse colon) were made. On opening the resected bowel, no pathological lead point was found. Patient was discharged in good general condition on fifth post-operative day of procedure. Sitz bath and care of perineal wound was advised. Patient was in regular follow up or two months with satisfactory condition. However, he did not turn up in third month. On telephonic inquiry, it was informed that the patient developed ileostomy diarrhoea and succumbed to dehydration.