Surgical treatment of neonatal jejunoileal atresia requires highly specialized skills, but its rarity makes training opportunities sparse. We aimed to address this by developing and evaluating a low-cost, high-fidelity, modular simulator for comprehensive training in neonatal laparotomy and small bowel atresia repair. Our design consisted of three primary components: bowel, abdominal wall, and abdominal cavity. 3D-printed molds were used to cast silicone models of type II and type IIIa atretic bowel with its mesentery. The abdominal wall was created by layering molded silicone and fabric. A small 3D-printed enclosure with an opening and bony landmarks was designed to simulate the neonatal abdomen. The material cost per model was ∼$16.88 USD, with each subsequent use costing ∼$5.09 USD. Eight expert surgeons and eight surgical trainees performed simulated atresia repairs and stoma creations. Participants rated face and content validity on a 5-point Likert scale. Videos of the simulated procedures were evaluated by an attending pediatric surgeon to assess construct validity by comparing performance between experts and trainees. The highest mean realism ratings were for surface anatomy (4.06) and anatomical structure (4.06). Content validity responses were positive (mean ratings >4), indicating that participants found the model thorough and valuable. Trainees made significantly more mistakes (p = 0.001) and completed fewer tasks (p = 0.01) than experts. Our simulator demonstrated strong face, content, and construct validity. It offers an accessible, cost-effective training tool, with promise for implementation in both high- and low-resource settings with limited surgical training opportunities.

Small bowel atresia is a leading cause of neonatal intestinal obstruction and is frequently associated with postoperative gastrointestinal dysmotility. While factors like enteric nervous system alterations have been studied, the role of interstitial cells of Cajal (ICCs), the gut's pacemaker cells, remains under-investigated. This study aimed to assess the density and distribution of ICCs in the atretic, proximal, and distal bowel segments in neonates with small bowel atresia and correlate their presence with postoperative outcomes. A prospective study was conducted over two years at Institute of Child Health Niloufer Hospital, Hyderabad, including 44 neonates diagnosed with various types of small bowel atresia. Resected bowel segments were analyzed histologically and immunohistochemically using anti-CD117 (c-Kit) antibodies to identify ICCs. Clinical parameters such as age, type and location of atresia, postoperative bowel function, and survival were documented and statistically correlated with ICC distribution. Among the 44 neonates (52.27% female), jejunal and ileal atresias were most common. The majority presented within the first five days of life. CD117 staining revealed sparse or absent ICCs in the atretic and proximal segments in neonates with delayed bowel function and poorer outcomes. In contrast, higher ICC expression was significantly associated with earlier stool passage and improved survival (p < 0.05). A reduction in ICCs is a notable pathological feature of small bowel atresia. Their density in resected bowel segments significantly influences postoperative bowel motility and survival. ICC density assessment may serve as a prognostic indicator and guide surgical planning in affected neonates.

Different disease entities that cause gastrointestinal (GI) obstruction have been studied in isolation; however, no description of GI obstruction in neonates and infants in South Africa could be identified. This study aims to describe the profile of GI obstruction in neonates and infants at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2016 to December 2019. This was a retrospective record review conducted on all patients < 1 year of age with GI obstruction admitted to CHBAH. Data on age at presentation, sex, presenting symptoms, aetiology, diagnostic imaging, operative and non-operative management, complications, and 30-day mortality were collected. A total of 299 patients were enrolled in this study. They were predominantly male (n = 175, 58.53%) and were neonates at presentation (n = 177, 59.20%). Congenital malformations (n = 203, 67.89%) were more common than acquired conditions (n = 96, 32.11%). Anorectal malformation (ARM) and small bowel atresia were the most common congenital condition (n = 61, 20.40%; n = 34, 11.37% respectively). Intussusception was the most common acquired condition (n = 78, 26.08%). The morbidity rate was 95 (31.77%) with nosocomial sepsis and surgical site sepsis accounting for 49 (51.58%) of the morbidities. Mortality rate was 16 (5.35%) and 10 (62,5%) of the mortalities had associated nosocomial sepsis. Congenital malformations of the GI tract are more common than acquired pathologies in neonates and infants in CHBAH. Sepsis causes significant morbidity in the postoperative period.

A 34-year-old woman (gravida 2, para 0) with suspected fetal small-bowel atresia on ultrasound underwent magnetic resonance imaging (MRI) at 33 weeks 3 days of gestation. In addition to small bowel atresia, a teardrop-shaped hematoma was observed adjacent to the umbilical cord associated with an umbilical cord ulcer (UCU). The fetus was delivered by induced labor on diagnosis of intrauterine fetal death. UCUs were macroscopically observed on the surface of the umbilical cord. Ultrasonography is helpful in the diagnosis of UCU. Moreover, the MRI findings on UCUs adjacent to the umbilical cord in the case of congenital small bowel atresia should be observed carefully, especially after 30 weeks of gestation. MRI findings may lead to the detection of UCU and improve fetal outcome. Therefore, we should be aware of its findings.

Colonic atresia (CA) is associated with Hirschsprung disease (HD) in up to 10% of cases. Therefore, some surgeons elect to complete proximal diversion at the initial operation. We sought to better define the incidence of concurrent HD and evaluate practice patterns regarding diversion for CA. The Pediatric Health Information System (PHIS) database was used to identify patients with CA from 2013 to 2022. Patients with small bowel atresia, anorectal malformation, gastroschisis, or first operation after 14 days of age were excluded. Index and subsequent operations were defined. Complications, time to enterostomy closure, and unplanned operations were evaluated. HD was diagnosed in 8 (9.5%) patients and 7 of these were initially diverted. Diverted and anastomosed patients were demographically similar. In the 58 (69%) patients initially diverted, 19 (33%) had an ileostomy. Continuity was restored with an ileo-colic anastomosis in 63% of diverted and 27% of primarily anastomosed patients. Of those initially managed with a colostomy, 53% ultimately had a colo-colonic anastomosis. Patients with primary anastomoses had fewer operations and received more days of parenteral nutrition. Other outcomes did not vary. In a large population of infants with CA, 9.5% had concurrent HD. Almost 70% of CA patients underwent initial diversion and only one with HD had a primary anastomosis. Patients managed with a primary anastomosis were substantially more likely to retain the proximal colonic segment, but had a similar incidence of complications. When intraoperative colonic biopsies are obtained, primary anastomosis is a safe and effective strategy for CA.