Neonatal Small Left Colon Syndrome Clinical Presentation

Updated: Nov 01, 2019
  • Author: Erik Skarsgard, MD; Chief Editor: Harsh Grewal, MD, FACS, FAAP  more...
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Presentation

History and Physical Examination

The clinical features of infants described in seven English-language case series of neonatal small left colon syndrome (NSLCS) are summarized in Table 1 below.

Table 1. Clinical Features of Infants Described in English-Language Case Series of Neonatal Small Left Colon Syndrome (Open Table in a new window)

Investigator

Number of Cases

Median Gestational Age

(wk)

Maternal History of Diabetes Mellitus

Other Perinatal History

Intestinal Perforation

Mortality

Surgery Performed

Davis et al [5]

20

Not stated

8

1 (Rh disease)

0

1 (death due to unrelated cause)

2

Berdon et al [15]

11

37

3

4 (eclampsia)

0

0

2

Philippart et al [7]

8

38

8

6 (eclampsia)

2

0

4

Rangecroft [16]

5

37

1

0

0

0

1

Stewart et al [17]

4

37

3

2 (eclampsia)

3

1

3

Woodhurst and Kilman [18]

2

36

0

0

1

1

2

Falterman and Richardson [19]

2

37

0

2 (psychotropic drug use)

0

0

0

Total

52

38

23 (44%)

15 (29%)

6 (12%)

3 (6%)

14 (27%); 7 of 14 underwent colostomy for incorrect diagnosis of Hirschsprung disease

Most infants with NSLCS are born at or near term and are of normal birth weight. Approximately 50% have a history of maternal diabetes mellitus, and other maternal comorbidities (usually eclampsia), which contribute to neonatal stress, may also be present. All patients do not pass meconium within the first 24 hours of life, and they all develop abdominal distention with bilious vomiting or nasogastric aspirates. A small number of infants develop progressive distention leading to perforation, typically in the cecum, within the first 24-36 hours of life.