Bowel injury in a neonate post cord clamping

ABSTRACT

To report a case of a newborn male baby with a congenital hernia of the umbilical cord who suffered an accidental intestinal injury caused by an umbilical clamp. A four day old male newborn, full term, delivered by caesarean section with a birth weight of 4.5Kg was admitted to the pediatric unit of due to fever, bilious vomiting, decreased activity and poor oral feeding. On examination it was noted that he had a wide based umbilical cord with a clamp applied at 2cm from the anterior abdominal wall. The abdomen was distended, tender on palpation with visible peristalsis; the nasogastric tube contained bile stained liquid. A barium enema showed that the dye went towards the umbilicus. A laparotomy was done; the umbilical clamp was released, followed by resection of the gangrenous bowel and an end-to-end anastomosis, repair of a minor omphalocele and umbilicoplasty. Where there is a wide based umbilical cord with an umbilical cord clamp situated close to the anterior abdominal wall in asymptomatic patient, this may suggest iatrogenic intestinal injury and immediate surgical intervention is advised to decrease the associated morbidity and mortality