Unexpected Spectrum of Pediatric Intestinal Obstruction: Case Series of Rare and Unusual Etiologies

Abstract

Introduction: Intestinal obstruction is a frequent surgical emergency in children, yet rare and atypical etiologiesmay pose significant diagnostic and therapeutic challenges. Rapid identification and timely surgical managementare crucial to prevent bowel ischemia and adverse outcomes.Patients and methods: This retrospective case series reviewed eight children treated for uncommon causes ofintestinal obstruction at Tanta University Hospital between January 2021 and January 2025. Patient demographics,clinical presentation, imaging, operative findings, and outcomes were analyzed.Results: The study included patients ranging in age from the neonatal period to 14 years. The etiologies identifiedwere strangulated Morgagni hernia, pyloric web, jejunal phytobezoar, ileal atresia associated with omphaloceleminor, Peutz–Jeghers syndrome with solitary ileal polyp, Meckel’s diverticulum with mesodiverticular band,ascending colonic atresia, and sigmoid volvulus. The exact cause of obstruction was often uncertain before surgeryand confirmed intraoperatively in most cases. Each patient underwent definitive operative correction tailored to theunderlying pathology. Postoperative recovery was smooth in seven patients; one developed a wound complicationthat resolved after re-exploration. There were no deaths, and all children demonstrated favorable long-termoutcomes on follow-up.Conclusion: Uncommon causes of intestinal obstruction can closely mimic more frequent conditions, leadingto diagnostic delay. A high index of suspicion, careful imaging interpretation, and early surgical interventionare essential for successful management. Reporting such rare entities broadens clinical understanding, improvesdiagnostic awareness, and enhances perioperative decision-making in pediatric surgical practice.