Too late to thrive: Delayed diagnosis of congenital intestinal obstruction in infants presenting with failure to thrive, a case series
DOI:
https://doi.org/10.65221/0194Keywords:
Congenital Abnormalities, delayed diagnosis, intestinal atresia, intestinal obstruction, failure to thrive, malnutritionAbstract
Failure to thrive in infancy refers to inadequate weight gain or growth and may result from a range of nutritional, medical, or psychosocial conditions. Although intestinal obstruction is a recognised neonatal surgical emergency, it is rarely considered a cause of failure to thrive beyond the newborn period. Delayed or incorrect diagnosis in such cases may result in prolonged malnutrition and increased perioperative risk. Three infants presented with failure to thrive secondary to delayed or missed diagnosis of congenital intestinal obstruction. The cases included a 17-week-old infant with ascending colonic stenosis, an 8-month-old infant with a fenestrated Type I ileal atresia, and a 13-month-old child with partial duodenal obstruction due to malrotation with Ladd’s bands. All patients had persistent gastrointestinal symptoms from early infancy and presented with severe growth failure. These cases highlight the potential for congenital intestinal obstruction to present atypically with feeding intolerance and poor weight gain. A high index of suspicion and early referral for surgical evaluation are essential to improve outcomes in affected infants.
References
Cooke R, Goulet O, Huysentruyt K, Joosten K, Khadilkar AV, Mao M, Meyer R, Prentice AM, Singhal A (2023). Catch‐Up growth in infants and young children with faltering growth. Journal of Pediatric Gastroenterology and Nutrition 77(1):7-15. https://doi.org/10.1097/mpg.0000000000003784.
Dahal P, Dawadi K, Parajuli S (2023). Delayed presentation of congenital sigmoid colon stenosis: a rare entity. BJR|Case Reports 10(1):uaae003. https://doi.org/10.1093/bjrcr/uaae003.
De Sanctis V, Soliman A, Alaaraj N, Ahmed S, Alyafei F, Hamed N (2021). Early and long-term consequences of nutritional stunting: from childhood to adulthood. Acta Bio-medica Dell’Ateneo Parmense/Acta Biomedica 92(1):e2021168. https://doi.org/10.23750/abm.v92i1.11346.
Ekenze SO, Ezomike UO, Nwachukwu IE, Ariom AI, Chukwubuike KE, Nwangwu EI, Onoh US, Uwah EA. (2019). Chronic bowel obstruction from colonic stenosis in early infancy-A report of two cases. Malawi medical journal 31(1):82-85. https://doi.org/10.4314/mmj.v31i1.14
Emmanuel D, Enwani I, Ukibe N, Franco A, Duru B (2023). Prevalence and determinance of failure to thrive among children in Bayelsa State, Nigeria. International Journal of Health Sciences and Research 13(12):77-86. https://doi.org/10.52403/ijhsr.20231210.
Franceschi R, Rizzardi C, Maines E, Liguori A, Soffiati M, Tornese G (2021). Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting. Italian Journal of Pediatrics 47(1). https://doi.org/10.1186/s13052-021-01017-4.
Garcia DJ, Hamade M, Lin L, Matias M, Sobhan A, Zaritsky M, Thorson C (2024). Failure to thrive in infant secondary to congenital colonic stenosis: a case report. Journal of Surgical Case Reports (12):rjae766. https://doi.org/10.1093/jscr/rjae766.
Haloho LV, Nurnaningsih N, Paryanto E (2023). Preoperative hypoalbuminemia and severe acute malnutrition as prognostic factors for postoperative complications in major abdominal surgery: A single-center retrospective study. Paediatrica Indonesiana 63(5):389-394. https://doi.org/10.14238/pi63.5.2023.389-94.
Jumbi T, Mwika P (2020). Chronic partial colonic obstruction from a congenital web. Journal of Pediatric Surgery Case Reports 57:101442. https://doi.org/10.1016/j.epsc.2020.101442.
Krasaelap A, Kovacic K, Goday PS (2019). Nutrition management in pediatric gastrointestinal motility disorders. Nutrition in Clinical Practice 35(2):265-272. https://doi.org/10.1002/ncp.10319.
Lamichhane A, Sharma R, Rajkarnikar R, Awale R, Shrestha P, Oli NC (2020). A five years old child with failure to thrive and vomiting presenting as a diagnostic dilemma: a case report. Journal of Nepal Medical Association 58(228):600-603. https://doi.org/10.31729/jnma.5134.
Nassiri H, Bouljrouf J, Ochan M, Kisra M (2025). Delayed diagnosis of type I jejunal atresia in an infant with intractable vomiting: a case report. Journal of Surgical Case Reports 2025(6):rjaf429. https://doi.org/10.1093/jscr/rjaf429.
Sarkar S, Apte A, Sarkar N, Sarkar D, Longia S (2011). Vomiting and food refusal causing failure to thrive in a 2 year old: an unusual and late manifestation of congenital duodenal web. BMJ Case Reports 2011:bcr0120113779. https://doi.org/10.1136/bcr.01.2011.3779.
Seltz LB (2008). Case 1: A green case of failure to thrive. Paediatrics & Child Health 13(8):685-687. https://doi.org/10.1093/pch/13.8.685.
Sharma C, Borkar NB, Ashwin C, Sinha C (2024). Delayed presentation of malrotation after infancy: a systematic review based on clinical presentations, associated anomalies, diagnosis, and management. Journal of Indian Association of Pediatric Surgeons 29(5):417-434. https://doi.org/10.4103/jiaps.jiaps_105_24.
Smith A, Shah M, Badireddy M (2023). Failure to thrive. In: StatPearls - NCBI Bookshelf. Treasure Island, Florida, United States of America: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459287/
Ssentongo P, Candela X, Amoah AKS, Opare JN, Arkorful TE, Tsai AY, Amponsah-Manu F, Oh JS (2018). Jejunal atresia causing failure to thrive: The role of camera mobile phones in aiding diagnosis in limited resource settings. Journal of Pediatric Surgery Case Reports 36:67-69. https://doi.org/10.1016/j.epsc.2018.04.015.
Wong S, Landisch R, Ruiz R, Datta S, Fuchs J (2024). Late presentation of type-I jejunal atresia in an infant: a case report. Journal of Pediatric Surgery Case Reports 110:102891. https://doi.org/10.1016/j.epsc.2024.102891.
