Recurrent intestinal obstruction in the neonatal period.

Between 1956 and 1962, 238 newborn infants underwent laparotomy for intestinal obstruction at the Surgical Department of the Children's Hospital in Munich. This paper is concerned with 24 cases where a second operation was necessary because of persistence or recurrence of intestinal obstruction. Table 1 shows the initial pathology and the findings when the abdomen was reopened. The commonest cause of recurrent obstruction was early and intensive adhesion (Table 2). There seem to be two reasons for this complication: first, injury to the intestinal serosa by extensive handling and by drying of the bowel while it lies outside the peritoneal cavity, and secondly a long period of aperistaltic ileus which increases the possibility of fibrous bands forming between the bowel loops. The early post-operative course is, therefore, important in this respect and we believe that peristalsis should be stimulated to return as soon as possible. Intraperitoneal cortisone may also be of value in preventing formation of adhesions; early results appear promising but are not yet conclusive. It seems to carry little danger to the anastomosis. In several cases we found that the end-to-end anastomosis was either not patent or was not functioning properly. There were several reasons for this. When anastomosing two bowel ends that differ considerably in diameter it is necessary to cut the distal one very obliquely in order to obtain equal lumina. This may lead to considerable angulation of the intestine at the anastomosis, which predisposes to further kinking, and eventually complete obstruction can result. In some cases we think we were too economical with the resection of the blind or prestenotic intestinal loop. Nixon's (1960) work on this subject is, of course, well known and our experience confirms his view thbt one must, if possible, be generous in resecting the proximal non-functioning bowel. We feel that some of the hazards we had to deal with were due to a situation