Prognosis after resection of small bowel in the newborn.

This report concerns the results in a series of children who have had a resection of small bowel for obstruction in the neonatal period. The recovery rate after this procedure has improved, particularly at special centres, but the presence of multiple abnormalities such as cardiovascular disorders and prematurity increases the risk of operation. The first few days of the post-operative period are often hazardous after complete obstruction from atresia (single or multiple), due largely to disparity in the size of the anastomosed bowel above and below the obstruction. The distended and hypertrophied proximal gut, sometimes containing viscid meconium, contrasts with the collapsed distal bowel which never having functioned is small in diameter. The excision of dilated bowel above the obstruction, advocated by Gross (1953), Nixon (1955) and others, has helped the recovery of such cases, but where the whole of the proximal gut is distended in high jejunal obstruction, its excision is often not possible, and recovery of intestinal function may be greatly delayed. Massive resections may be necessary in volvulus intestinalis neonatorum or mesenteric vascular thrombosis. Animal experiments (Flint, 1912) and studies after massive resections in adults (Haymond, 1935) indicate that at least half of the intestine can be removed with recovcry. Preservation of the ileum is more important than the jejunum for absorption in general (Kremen, Linner and Nelson, 1954; Benson, 1955), and absorption of vitamin B12 in particular (Booth and Mollin, 1957; 1959) is dependent on the distal small bowel. After resection of a moderate length of bowel, dysfunction with intestinal hurry may persist for several weeks, but ultimately the bowel functions normally (Booth, Evans, Menzies and Street, 1959). This recovery may be due to compensatory hypertrophy of intestinal villi, as shown in animal experiments (Flint,