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Lesson of the Week: Iatrogenic ileal obstruction: a complication of umbilical cord clamping

We report a case of a neonate referred with bilious vomiting and abdominal distension, who had a broad based umbilicus. Small bowel obstruction secondary to clamping of an exomphalos minor that contained ileum was evident at laparotomy. This complication arose as a result of failure to diagnose the exomphalos minor and to clamping of the umbilical cord too close to the abdominal wall.

A 3 day old boy was referred with a 48 hour history of bilious vomiting that was associated with abdominal distension. The infant had been born at term by spontaneous vaginal delivery and weighed 2.07 kg. The pregnancy had been unremarkable with no history of polyhydramnios; a prenatal ultrasound scan had been normal. He had had meconium stained liquor, but no resuscitation had been required. He was started on breast milk feeds, he passed meconium, and was transferred to the ward.

The infant was initially well …