Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 34511

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : EC18 - EC22 Full Version

A Clinicopathological Study of Developmental and Acquired Causes of Intestinal Obstruction in Paediatric Population- A Retrospective Study

Published: June 1, 2022 | DOI:
Yogita Talpade, Yasmeen Khatib, Prajakta Amit Gupte, Bhuvaneshwari Kandalkar, Manisha Khare, Vinaya Shah

1. Assistant Professor, Department of Pathology, HBT Medical College, Dr R N Cooper Hospital, Mumbai, Maharashtra, India. 2. Additional Professor, Department of Pathology, HBT Medical College, Dr R N Cooper Hospital, Mumbai, Maharashtra, India. 3. Assistant Professor, Department of Pathology, HBT Medical College, Dr R N Cooper Hospital, Mumbai, Maharashtra, India. 4. Professor and Ex-Head, Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. 5. Professor and Head, Department of Pathology, HBT Medical College, Dr R N Cooper Hospital, Mumbai, Maharashtra, India. 6. Additional Professor, Department of Pathology, HBT Medical College, Dr R N Cooper Hospital, Mumbai, Maharashtra, India.

Correspondence Address :
Dr. Yasmeen Khatib,
Department of Pathology, C Wing, 1st Floor, Hospital building, Dr RN Cooper hospital, Mumbai-400056, Maharashtra, India.


Introduction: Intestinal Obstruction (IO) in the paediatric age group can be due to a variety of developmental and acquired causes which depend on the age at presentation. Histopathological examination of the resected intestine can provide definite evidence of underlying aetiology.

Aim: To analyse the spectrum of lesions causing IO and it’s relation with clinicopathological features.

Materials and Methods: This was a retrospective study conducted in the Department of Pathology at Seth G.S Medical College and Dr. R. N. Cooper Hospital, Mumbai, Maharashtra, India. Gross and microscopy of 70 surgically resected specimens of patients with IO, received over a period of five years, from January 2009 to December 2013, were studied after getting ethical clearance. Clinical details were retrieved from the records. Lesions were classified as developmental and acquired which were further categorised into infective, neoplastic and miscellaneous categories. Data was analysed using Microsoft excel 2010 and was expressed as frequency and percentage.

Results: Out of the 70 cases studied there were 40 males and 30 females. There were 37 cases less than 1 month old, 13 cases between one month to 1 year age and 20 cases between 1 year to 12 years of age. The developmental category comprised of 52/70 cases (74.29%) with 17 cases of Meckel’s diverticulum,16 cases of intestinal atresia, three cases each of mesenteric cysts and duplication cysts, five cases of duodenal webs, four cases of congenital bands, one case each of lymphangiectatic cyst, malrotation, blind ileal loop and meconium ileus. In the acquired category there were three cases of tuberculosis and one case each of fungus and Ascaris infection. In the neoplastic category there were five cases of polyps and one case each of cystic teratoma and Burkitt lymphoma. There were three cases of volvulus, two of perforation and one case of intussusception.

Conclusion: The present study highlights the various causes of IO in children from neonatal period up to 12 years of age. With proper gross and microscopic examination it was possible to give confirmed diagnosis which is necessary for further management of the patient.


Cyst, Infection, Intestinal atresia, Meckel’s diverticulum, Neoplasm

The IO in paediatric age group can be due to a variety of developmental and acquired causes which differ in neonatal and older age groups (1). It is one of the most common surgical emergency seen in paediatric age group with significant mortality and morbidity. Mode of presentation is acute in majority of the cases. Patients present with abdominal distension, vomiting, abdominal pain, constipation and failure to pass meconium (2). Common causes of surgical specimens received due to developmental IO which are present mainly in the neonatal period include intestinal atresias, intestinal webs, congenital bands, Meckel’s diverticulum, meconium ileus and malrotation (3). Acquired causes include infections like tuberculosis, worm infestations, neoplasms like polyps, lymphoma and other causes like intussusception, volvulus and perforation (4). Earlier studies done on the causes of IO have focussed on clinical presentation and management (1),(2),(3),(4). However, analysis of gross and histopathological features did not reflect in these studies. Surgical pathology specimens can help to confirm the diagnosis and also unravel the predisposing factors which can lead to IO. Hence, this study was undertaken to classify, study the various causes and complications of IO in children and also to analyse its relation with clinicopathological features.

Material and Methods

This was a retrospective study conducted in the Department of Pathology at Seth G.S Medical College and Dr .R. N. Cooper Hospital, Mumbai, Maharashtra, India. It was done on all surgical pathology specimens of paediatric patients operated for IO for five years between January 2009 and December 2013. Data was analysed between January 2021 to June 2021. Institutional Ethics Committee (IEC) permission was obtained (ethical clearance number - IEC/171/2012).

Inclusion criteria: Specimen of IO cases, less than 12 years of age were included in the study.

Exclusion criteria: Functional obstructions due to Hirschsprung’s disease were excluded from the study.

Sample size: Out of a total of 798 paediatric gastrointestinal specimens received during the study period 70 cases showed features of IO and comprised the study population.

Data collection: The medical records of the patients were retrieved and analysed with respect to age, gender, symptoms of abdominal pain, distension of abdomen, constipation, inability to pass stools, vomiting, X-ray findings, preoperative diagnosis and diagnosis made during exploratory laparotomy.

Gross examination of all the specimens was done and the site, size, external appearance, cut surface, cystic change, intussusception, stricture, gangrene, perforation and peritonitis were noted. Representative histopathology sections were studied. Cases were divided based on aetiology into developmental and acquired causes which were further classified into infective, neoplastic and miscellaneous categories (volvulus, perforation and intussusception) (2).

Statistical Analysis

Data was collected and analysed using Microsoft excel 2010 and was expressed as frequency and percentage for different aetiologies.


Out of a total of 798 paediatric gastrointestinal specimens received during the study period 70 cases showed features of IO giving an incidence of 8.77%. Majority of the cases were in the age group of less than one month 37/70 (52.86%). There were 13 cases (18.57%) in the age group between 1 month to 1 year and 20 cases (28.57%) between 1 to 12 years. There were 40 males and 30 females children with a male:female ratio of 4:3. Patients presented with the complaints of abdominal distension in 45 cases (64.3%), pain in abdomen in 27 cases (38.6%), vomiting in 35 cases (50%) and inability to pass meconium/constipation in 20 cases (28.56%). There were 61 cases (87.14%) which presented with acute obstruction. Depending on the aetiology the cases were classified as developmental causes in 52 cases (74.29%), acquired in 18 case (25.71%) which were further divided as infective in 5 cases (7.14%), neoplastic in 7 cases (10%) and others in 6 cases (8.57%).

(Table/Fig 1) shows the developmental causes and (Table/Fig 2) depicts the acquired causes of IO along with the frequency, age distribution, male female ratio and salient histopathological findings. (Table/Fig 3)a-d shows the gross appearance of the cases. Meckels diverticulum and intestinal atresia shows gangrenous changes. Meckels Diverticulum (MD) ranged in size from 1-10 cm with giant MD more than 5 cms long in 6 out of 17 cases. Mesentric cyst shows a thin wall and duplication cyst is arising from the intestinal wall.

(Table/Fig 4)a-d shows microscopic features of MD, intestinal atresia, mesentric cyst and duplication cyst. There was one case of Burkitt’s lymphoma which presented as ileo-colic intussusception.

(Table/Fig 5)a shows the cut surface of Burkitt lymphoma with solid greyish white appearance. (Table/Fig 5)b shows the cut surface of teratoma with solid cystic variegated appearance. (Table/Fig 6)a,b shows the microscopic features of Burkitt lymphoma and cystic teratoma.

(Table/Fig 7) shows developmental and acquired causes of IO in children along with their complications like intussusception, structure, perforation gangrene and meconium peritonitis. Out of 70 children only 62 had secondary complications, rest of the cases did not have any secondary complication. There were 9 (12.86) cases of secondary intussusception. Mortality was seen in 3/70 cases (4.28%). In 15 cases more than one lesion was found. (Table/Fig 8) shows conditions with more than one lesion. (Table/Fig 9) shows the discordant cases with different preoperative/operative and histopathological diagnosis. In eight cases the final histopathological diagnosis was different from the clinical diagnosis.


A wide spectrum of developmental and acquired causes can be due to IO in paediatric population which requires prompt diagnosis and surgical intervention. These causes vary in the neonatal period and in older children. Regional variation is also seen with more number of infective causes like tuberculosis and ascariasis in developing countries (5). (Table/Fig 10) shows comparison of age, sex ratio and clinical symptoms found in present study as compared to other studies (2),(4),(6). Congenital/developmental causes of obstruction were found in 52/70 cases while acquired causes were divided as infective 5/70, neoplastic 7/70 and others 6/70 cases. Maheshwari M et al., (2) reported 58/94 congenital causes of obstruction and 36/94 as acquired causes in their study which was similar to present study.

Eight out of 10 cases presenting with intussusception were more than 1 year of age, 9 showing lead points formed by Meckel’s diverticulum, polyps and lymphoma while only one case of primary intussuception was found. This is unlike other studies because present study have analysed only surgically resected specimens (2),(4),(5).

Clinical presention and histopathological examination of both developmental and acquired causes of IO were analysed. MD was the commonest developmental abnormality seen in present study. 10/17 cases were seen in children more than 1year of age. Soomro S and Mughal SA (4) reported 16.4% cases of MD in their study of intestinal obstruction in children older than 1 year and Bhedi A et al., (6) reported an incidence of 12% and Gangopadhyay AN and Wardhan H reported incidence of 3.7% (5). Chen JJ et al., have mentioned that age, gender, inflammation and presence of ectopic gastric mucosa are factors associated with symptomatic MD (7). Severity of the symptoms also relates with the size of MD (8). In the present study 6/17 cases showed giant MD with size more than 5 cms long. Demonstration of cases with large size of MD, presence of ectopic gastric mucosa, bands, diverticulitis and leading point were seen in present study which explains the presentation of MD with obstruction, perforation, intussusception and gangrene.

Atresia can be divided into duodenal, jejunal, ileal and rectal and is an important cause of neonatal obstruction with some patients having associated congenital anomalies. In the present study, 16 cases of atresia all presenting with acute obstruction with 15/16 in neonatal age group were encountered. Subbarayan D et al., have reported association of atresia with duplication cysts and meconium cysts (9). Even in present study cases of ileal atresia were associated with duplication cysts, giant cystic meconium peritonitis and meconium ileus. All were type 1 atresia and showed submucosal fibrosis. Complications seen were perforation, gangrene and meconium peritonitis. According to previous studies Maheshwari M et al., reported an incidence of intestinal atresia to be 10.8% and Bhedi A et al., of 8% in their studies (2),(6).

In the present study there were two cases of jejunal web, two cases of duodenal web and one case of pyloric web. Histopathology showed submucosal fibrosis. Lin HH et al., have described 37 cases of gastrointestinal webs (10). Duodenal webs were associated with other congenital anomalies in 50% cases. Even in present study both cases of duodenal web were related with malrotation.

Duplication cysts are spherical structures attached to mesenteric border of the intestine and are lined by intestinal mucosa. According to the studies incidence of duplication cysts is low with obstruction presenting as the common complication (11),(12). Two cases were lined by intestinal mucosa and one with gastric mucosa. One was associated with duodenal band and one with intestinal atresia. All patients presented in the neonatal period. One case presented with meconium peritonitis. One case diagnosed as mesenteric cyst showed features of duplication cyst on histopathological examination. There was a discordance between preoperative and histopathology examination in 2/3rd cases.

Mesenteric cysts are believed to arise due to proliferation of ectopic lymphatic tissue which lack communication with remainder of lymphatics. They are more more common in ileal mesentery. Perrot M et al., reported an incidence of 1 per 20,000. Two out of three cases presented in older children (13). Grossly they were large in size and showed a columnar/cuboidal lining which is different from intestinal lining of duplication cyst. Tiwari C et al., have described 14 cases of cysts of GIT origin which included mesenteric cysts and duplication cysts (11).

One case of lymphangiectatic cyst was found in present study which is a rare presentation as reported by Prabhakaran K et al., (14). The diagnosis was possible only only on histopathological examination. Hence histopathological examination of all cystic leisons of GIT is advisable.

Four cases of congenital bands were seen, all in more than 1 month age group, causing intestinal obstruction. Two of them presented with gangrene and two with perforation. Soomro S and Mughal SA reported an incidence of 7.3% causing IO, while Gangopadhyay AN and Wardhan H reported an incidence of 6.17% causing IO (4),(5).

The acquired causes were more common in older age group. Among the infective causes three cases of tuberculosis presented in the ileo-caecal region with perforation and stricture which is frequently reported (15). Fungal infection presented with complications of perforation, and peritonitis in the neonatal period. Gangopadhyay AN and Wardhan H have reported an incidence of TB in 11% cases and ascariasis in 13.58% cases (5). A higher incidence of ascariasis causing IO has been reported by other studies as compared to the present study. This could be due to regional variation and medical treatment (5),(16).

Polyps in paediatric population are less frequent than in adults (17). All cases presented as lead points causing intussusception. On histopathology one was a Peutz’s-Jeghers polyp which is common in children and the other was an adenomatous polyp. One case of cystic teratoma was diagnosed as duplication cyst preoperatively and is rarely seen (18). The case of Burkitt lymphoma presenting as intussusception was identified as a polyp preoperatively. Thus histopathology was necessary in the correct diagnosis of neoplastic lesions which is necessary for further treatment (19).


Cases of functional obstruction like Hirshprung’s disease have not been included in the study. Cases of obstruction with surgical reduction but no excision were also excluded. As it was a retrospective study no follow-up of these patients could be done.


The present study highlights the various developmental and acquired causes of IO in children found on surgically resected specimens. A detailed gross and microscopic examination can show the exact aetiology of obstruction, type of infection or neoplasm and presence of complications for further management. In some cases more than one lesion can be found.


Venkatesh MA, Mahajan JK, Rao KLN. Etiological spectrum of acute intestinal obstruction. Indian Paediatrics. 2009;46:1102.
Maheshwari M, Tanwani R, Patel M, Joshi A, Jain R, Praneeth E. Intestinal obstruction in pediatric age group: A clinicopathological study. Ann Int Med Den Res. 2016;2(6):28-30. [crossref]
Saha AK, Ali MB, Biswas SK, Sharif HMZ, Azim A. Neonatal intestinal obstruction:patterns,problems and outcome. Bang Med J. 2012;45:6-10. [crossref]
Soomro S, Mughal SA. Intestinal obstruction in children. J Surg Pak Int. 2013;18(1):20-23.
Gangopadhyay AN, Wardhan H. Intestinal obstruction in children in India. Pediatric Surgery International. 1989;4(2):84-87. [crossref]
Bhedi A, Prajapati M, Sarkar A. A prospective study of intestinal obstruction in paediatric age group. International Surgery Journal. 2017;4(6):1979-83. [crossref]
Chen JJ, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC, et al. Meckel’s diverticulum: Factors associated with clinical manifestations. ISRN Gastroenterol. 2014;2014:390869. Doi: [crossref] [PubMed]
Almetaher HA, Mansour MA. Acute abdomen in children due to different presentations of complicated Meckel’s diverticulum: A case series. Ann Pediatr Surg. 2020;16(45). [crossref]
Subbarayan D, Singh M, Khurana N, Sathish A. Histomorphological features of intestinal atresia and its clinical correlation. Journal of Clinical and diagnostic Research. 2015;9(11):26-29. [crossref] [PubMed]
Lin HH, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC, et al. Congenital webs of the gastrointestinal tract: 20 years of experience from a pediatric care teaching hospital in Taiwan. Pediatrics & Neonatology. 2012;53(1):12-17. [crossref] [PubMed]
Tiwari C, Shah H, Waghmare M, Makhija D, Khedkar K .Cysts of gastrointestinal origin in children: Varied presentatation.Clin Colon Rectal Surg. 2008;21(4):280-85.
Liaqat N, Latif T, Khan FA, Iqbal A, Nayyar SI, Dar SH. Enteric duplication in children: A case series. Afr J Paediatr Surg. 2014;11:211-14. [crossref] [PubMed]
Perrot M, Bründler M, Tötsch M, Mentha G, Morel P. Mesenteric cysts. Toward less confusion. Dig Surg. 2000;17:323-28. [crossref] [PubMed]
Prabhakaran K, Patankar JZ, Loh DL, Ahamed Faiz Ali MA. Cystic lymphangioma of the mesentery causing intestinal obstruction. Singapore Med J. 2007;48:265-67.
Mirza B, Ijaz L, Saleem M. Surgical aspects of intestinal tuberculosis in children: Our experience. African Journal of Paediatric Surgery. 2011;8(2):185-89. [crossref] [PubMed]
Shiekh KA, Baba AA, Ahmed SM, Shera AH, Patnaik R, Sherwani AY. Mechanical small bowel obstruction in children at a tertiary care center in Kashmir. African Journal of Paediatric Surgery. 2010;7(2):81-85. [crossref] [PubMed]
Vincent RA, Bernabe K. Polyps in children. Clin Colon Rectal Surg. 2008;21(4):280-85. [crossref] [PubMed]
Destro F, Maestri L, Meroni M, Pergola EL, Andronache AA, Clemente C, et al. Colonic mature cystic teratoma. Journal of Pediatric Surgery Case Reports. 2019;41:57-59. [crossref]
Tiwari C, Khedkar K, Jayaswal S, Shah H. Burkitt’s lymphoma presenting as intussusception in four children. Pediatr Oncall J. 2016;13:71-73. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/53053.16508

Date of Submission: Oct 28, 2021
Date of Peer Review: Dec 28, 2021
Date of Acceptance: Mar 22, 2022
Date of Publishing: Jun 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

• Plagiarism X-checker: Oct 29, 2021
• Manual Googling: Mar 21, 2022
• iThenticate Software: May 19, 2022 (6%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)