MODERN METHODS OF DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF PARTIAL CONGENITAL INTESTINAL OBSTRUCTION IN NEWBORNS AND INFANTS

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 109 MODERN METHODS OF DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF PARTIAL CONGENITAL INTESTINAL OBSTRUCTION IN NEWBORNS AND INFANTS M.Sh. Boboyev1, Zh.B. Sattarov2 Tashkent State Medical University (TSMU)1,2 https://doi.org/10.5281/zenodo.17451834 Abstract. The article presents the results of an analysis of the incidence and clinical variants of congenital partial intestinal obstruction (CPIO) in 123 pediatric patients observed during the period of 2015–2022. All patients underwent a comprehensive examination that included clinical and laboratory methods as well as radiological diagnostics such as ultrasound, X-ray examination, and computed tomography. The clinical manifestations of the disease and the specific features of the diagnostic process were analyzed in detail, depending on the anatomical localization and type of intestinal obstruction. The study identified factors that complicate the course of CPIO and proposed ways to optimize the diagnosis and early detection of this pathology. Keywords: congenital partial intestinal obstruction, diagnosis, newborns. Introduction. Congenital partial intestinal obstruction (CPIO) is a rare but clinically significant pathology, occurring in approximately one out of 66,000 newborns and accounting for 1.8% to 15% of all cases of congenital intestinal obstruction [2,7]. The first description of this anomaly is attributed to Binninger (1673) [6,9]. A distinctive feature of CPIO is the high frequency of its association with other congenital anomalies, which are detected in almost half of patients (up to 47%) [3]. Despite the long history of observation of this pathology, scientific literature remains limited. The majority of publications describe cases of complete membranous obstruction, which are mainly diagnosed in the neonatal period and confirmed exclusively intraoperatively [1,8]. Mentions of partial forms of atresia, their clinical course, and diagnostic criteria remain isolated, which significantly complicates timely diagnosis and the choice of treatment tactics. At present, there are no comprehensive studies devoted to modern algorithms of clinical diagnosis and approaches to the treatment of various forms of CPIO. The available publications mainly concern individual nosological forms, such as chronic duodenal or membranous obstruction, and do not cover the entire spectrum of anatomical and functional variants [7]. This leads to underestimation of the diversity of clinical manifestations and, consequently, to diagnostic errors at the prehospital and early hospital stages [4–5,10]. Thus, congenital partial intestinal obstruction remains a relevant problem in neonatal surgery. Conducting systematized studies aimed at clarifying diagnostic criteria, classifying clinical forms, and improving therapeutic approaches appears to be a necessary condition for increasing survival rates and improving the quality of medical care for this category of patients. Objective of the Study. Improvement of comprehensive diagnostic approaches for the detection of congenital partial intestinal obstruction in newborns and infants. Materials and Methods. The study is based on the results of the examination and treatment of 463 children hospitalized during the period from 2015 to 2022 with clinical manifestations of congenital partial intestinal obstruction (CPIO) and concomitant abdominal pathologies. The study analyzed the distribution of various forms of congenital intestinal SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 110 obstruction, including duodenal atresia and stenosis, membranous form, arteriomesenteric obstruction, embryonic bands, annular pancreas, and other anomalies. Special attention was paid to the assessment of the incidence of CPIO among this group of patients. Among the 463 examined children, 123 (26.6%) were diagnosed with CPIO at the age of 1 day to 1 year. Of these, 105 (85.4%) had the high form of CPIO, and 18 (14.6%) had the low form. Gender distribution revealed a predominance of girls — 72 (58.5%), while boys accounted for 51 children (41.5%). The clinical material was subjected to retrospective analysis followed by comparison with a control group. The main group (MG) included 67 patients (54.5%) who were under observation between 2019 and 2022, whereas the comparison group (CG) consisted of 56 patients (45.5%) examined and treated between 2015 and 2018. The methodological basis of the study comprised improved diagnostic and therapeutic algorithms that have been implemented in clinical practice in recent years. Between 2015 and 2022, ultrasound examination (US) was performed in 50,790 pregnant women at various stages of gestation at the Perinatal Center of the Ministry of Health of the Republic of Uzbekistan. During the same period, 45,580 deliveries were recorded, of which 45,127 (99.0%) were live births and 453 (0.99%) were stillbirths. The diagnosis of congenital intestinal obstruction was confirmed in 463 newborns, accounting for 1.0% of the total number of live births during the study period. To assess the functional state of the gastrointestinal tract, a comprehensive diagnostic approach was used, including the analysis of anamnestic data, clinical complaints, and objective symptoms, as well as a wide range of laboratory and instrumental methods. The diagnostic program included: X-ray examination, gastrointestinal contrast passage radiography, irrigography, antenatal ultrasonography of pregnant women and fetuses, abdominal ultrasound, Doppler sonography of intestinal vessels, computed tomography (CT), multislice computed tomography (MSCT), echocardiography, and neurosonography. Results and Discussion. The analysis was conducted taking into account comprehensive data on the health status of mothers, their socio-demographic background, obstetric history, somatic condition, features of the current pregnancy and delivery, as well as the results of antenatal screening. In addition, factors related to the condition of the mother and fetus were considered. The study involved 123 newborns who were under observation with the diagnosis of congenital partial intestinal obstruction (CPIO) during the period from 2015 to 2022. In the medical history of pregnant women, numerous risk factors contributing to pregnancy complications at early stages were identified. In particular, teratogenic effects associated with the use of medicinal agents— including antibiotics of various groups, nonsteroidal anti-inflammatory drugs, and antithyroid medications during critical periods of gestation—were recorded in 45 patients (36.6%). TORCH group infections were diagnosed in 17 women (13.8%), and exposure to pesticides was observed in 8 cases (6.5%). Polyhydramnios was noted in 53 patients (43.1%) in their medical history. The clinical manifestations of CPIO and their onset patterns in the studied groups of patients are presented in detail in Table 1. Table 1. Clinical manifestations in patients with CPIO (n = 123) Indicators Study groups CG MG abs M±m,% Р abs M±m,% Р SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 111 Clinical signs of CPIO (abdominal distension, restlessness, vomiting, delayed stool and gas passage) 28 50,0±6,68 2 = 53,714; р = 0,000 29 43,28±6,05 2 = 45,030; р = 0,000 Subacute or recurrent abdominal pain 11 19,64±5,31 13 19,40±4,83 Intestinal bleeding 3 5,36±3,01 4 5,97±2,89 Intestinal malabsorption 1 1,79±1,77 2 2,99±2,08 Tumor-like mass in the abdominal cavity 3 5,36±3,01 5 7,46±3,21 Various combinations of two signs 10 17,86±5,12 14 20,9±4,97 p Pearson’s chi-square = 0,850; р = 0,974 Intrauterine growth restriction, along with concomitant factors complicating the process of neonatal adaptation, had a negative impact on the course of CPIO, making surgical interventions more difficult and reducing the effectiveness of therapeutic measures. The combined or isolated influence of these factors contributed to the deterioration of the general condition in 42 patients (34.1%), in whom hypoxia and central nervous system ischemia were diagnosed. In addition, 49 patients (39.8%) developed respiratory distress syndrome, 3 patients (2.4%) had hyperbilirubinemia, 7 newborns (5.7%) demonstrated intrauterine growth restriction, 2 patients (1.6%) developed edematous syndrome, and 3 patients (2.4%) presented with disseminated intravascular coagulation (DIC syndrome), which further aggravated the clinical picture. The simultaneous presence of several pathological conditions was noted in 71 newborns (57.7%), which led to disturbances in body weight dynamics and complicated both early and late stages of neonatal adaptation. Among 123 newborns with a confirmed diagnosis of congenital partial intestinal obstruction (CPIO), 105 patients (85.4%) had the high form of obstruction, whereas 18 (14.6%) presented with the low form. A detailed distribution of the nosological types of high and low CPIO is presented in Table 2. The high form of congenital partial intestinal obstruction, identified in 105 newborns (85.4%), was caused by anatomical barriers at the level of the duodenum leading to partial obstruction of the intestinal lumen. The etiological structure included: duodenal stenosis — in 4 cases (3.8%), duodenal membranes — in 17 cases (16.2%), external compression of the duodenum by periduodenal adhesions — in 10 cases (9.5%), and annular pancreas — in 9 patients (8.5%). Most frequently, in 62 cases (59.1%), the high form of CPIO was associated with intestinal malrotation and fixation disorders. In three patients (2.9%), a mixed form of high obstruction was observed, caused by a combination of several anatomical factors. The low form of congenital partial intestinal obstruction was identified in 18 patients (14.6%) and clinically manifested with symptoms of partial intestinal obstruction. In this group, perforated intestinal membranes were diagnosed in 4 cases (22.2%), and congenital stenosis of the small intestine — in 3 cases (16.7%). In 7 patients (38.9%), the obstruction was caused by mechanical compression of the intestine due to adhesive processes and abnormal formations. In 4 cases (22.2%), the symptoms of lower intestinal obstruction were caused by malrotation. Table 2. Distribution of patients with CPIO by age and form of the disease (n = 123) Localization and morphological characteristics of Newborn s Up to 3 months From 3 to 6 months From 6 to 9 months From 9 to 12 months Total SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 112 partial intestinal obstruction ab s % ab s % ab s % a bs % ab s % a b s % Р 1. High forms of congenital partial intestinal obstruction Duodenal stenosis 2 1,63 1 0,81 1 0,8 1 0 0,0 0 0 0,0 0 4 3,3 2 = 110,190; р = 0,000 Duodenal membranes 15 12,2 0 2 1,63 0 0,0 0 0 0,0 0 0 0,0 0 1 7 13,8 External compression of the duodenum 14 11,3 8 4 3,25 0 0,0 0 1 0,8 1 0 0,0 0 1 9 15,4 Duodenal compression associated with malrotation 52 42,2 8 9 7,32 1 0,8 1 0 0,0 0 0 0,0 0 6 2 50,4 Combined multilevel forms 3 2,44 0 0,00 0 0,0 0 0 0,0 0 0 0,0 0 3 2,4 Р Pearson’s chi-square = 18,669; р = 0,097 2. Low forms of congenital partial intestinal obstruction Intestinal stenosis 3 2,44 0 0,00 0 0,0 0 0 0,0 0 0 0,0 0 3 2,44 2 = 2,000; р = 0,572 Intestinal membranes 3 2,44 0 0,00 0 0,0 0 0 0,0 0 1 0,8 1 4 3,25 External intestinal compression 5 4,07 1 0,81 1 0,8 1 0 0,0 0 0 0,0 0 7 5,69 Combination of low obstruction with malrotation 2 1,63 2 1,63 0 0,0 0 0 0,0 0 0 0,0 0 4 3,25 Р Pearson’s chi-square = 9,527; р = 0,390 Total: 99 80,4 9 19 15,4 5 3 2,4 4 1 0,8 1 1 0,8 1 1 2 3 100, 00 Conclusion. Congenital partial intestinal obstruction (CPIO) accounts for 26.6% of all cases of intestinal obstruction in newborns. The main etiological factors contributing to the development of CPIO include congenital anomalies of the intestinal tube (22.8%), intestinal malrotation (53.6%), associated organ pathologies (21.1%), and multifactorial causes (2.4%). Among the key risk factors for the formation of CPIO in the fetus are polyhydramnios (43.1%), teratogenic effects of medications (36.6%), TORCH infections (13.8%), and adverse environmental factors (6.5%). Antenatal diagnosis of CPIO is based on ultrasound examination, which serves as an effective screening method and allows identification of the main echographic signs — polyhydramnios and intestinal loop dilatation exceeding 15 mm during the second trimester of pregnancy, observed in 100% of the studied cases. In the postnatal period, the diagnostic accuracy of ultrasound significantly increases with the application of additional SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 113 diagnostic techniques, such as Doppler sonography, radiographic contrast studies, and computed tomography (CT) of the gastrointestinal tract. REFERENCES 1. Kozlov Yu.A., Podkamnev V.V., Novozhilova V.A. 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