Too late to thrive: Delayed diagnosis of congenital intestinal obstruction in infants presenting with failure to thrive, a case series

Abstract

Failure to thrive in infancy refers to inadequate weight gain or growth and may result from a range of nutritional, medical, or psychosocial conditions. Although intestinal obstruction is a recognised neonatal surgical emergency, it is rarely considered a cause of failure to thrive beyond the newborn period. Delayed or incorrect diagnosis in such cases may result in prolonged malnutrition and increased perioperative risk. Three infants presented with failure to thrive secondary to delayed or missed diagnosis of congenital intestinal obstruction. The cases included a 17-week-old infant with ascending colonic stenosis, an 8-month-old infant with a fenestrated Type I ileal atresia, and a 13-month-old child with partial duodenal obstruction due to malrotation with Ladd’s bands. All patients had persistent gastrointestinal symptoms from early infancy and presented with severe growth failure. These cases highlight the potential for congenital intestinal obstruction to present atypically with feeding intolerance and poor weight gain. A high index of suspicion and early referral for surgical evaluation are essential to improve outcomes in affected infants.