NEONATAL LOWER NEONATAL LOWER INTESTINAL INTESTINAL

OBSTRACTIONOBSTRACTION

Lower GI ObstractionLower GI Obstraction

Distal ObstructionDistal Obstruction

Signs of Intestinal Signs of Intestinal Obstruction:Obstruction:

1- pain>colic 1- pain>colic

2-vomiting >depend on the level2-vomiting >depend on the level

3-distention> the distal the obstruction the 3-distention> the distal the obstruction the more the distentionmore the distention

4-absolute constipation > early in large 4-absolute constipation > early in large bowel & late in small bowel .bowel & late in small bowel .

Hirchsprung’s DiseaseHirchsprung’s Disease

Barium EnemaBarium Enema

-common in males-common in males

-recto-sigmoid is most common-recto-sigmoid is most common

-s/s:failure to pass meconium in the 24h of life( imp)-s/s:failure to pass meconium in the 24h of life( imp)

,abdominal distention ,bilious vomiting ,abdominal distention ,bilious vomiting - In older children> constipation In older children> constipation - Dx: xray >dilated colonDx: xray >dilated colon

PR> gush of stoolsPR> gush of stools

unprepared enema> retention of bariumunprepared enema> retention of barium

Biopsy (gold one) Biopsy (gold one)

-Rx:- resuscitation-Rx:- resuscitation

- pull through procedure ( can be done after - pull through procedure ( can be done after colostomy) colostomy)

Cutaneous fistula rectourethral fistulaCutaneous fistula rectourethral fistula

Anorectal MalformationAnorectal Malformation

Cutaneous fistulaCutaneous fistula

recto-vistibular fistularecto-vistibular fistula

ARM( invertogram) ARM( invertogram)

Invertogram Cross table

ARM(rectal gas)ARM(rectal gas)

Distal LoopogramDistal Loopogram

Recto urethral Fistula

Colostomy PSARPColostomy PSARP

-It can be high or low type according to puborectalis -It can be high or low type according to puborectalis -low> female > recto-vistibular fistula-low> female > recto-vistibular fistula

-high> male> recto vasical-high> male> recto vasical

-associated with VACTERL -associated with VACTERL

-s/s:no anus ,fistula, UTI, bowel obstruction.-s/s:no anus ,fistula, UTI, bowel obstruction.

-Dx: physical examination ( the imp)-Dx: physical examination ( the imp)

cross table cross table

invertogram invertogram

xray> for rectal gas xray> for rectal gas

USUS

Rx:Rx:

Low type with fistula>>repair the fistula & Low type with fistula>>repair the fistula & anoplastyanoplasty

High type>>colostomy then anoplastyHigh type>>colostomy then anoplasty

X-Ray Muconium ileusX-Ray Muconium ileus

Muconium ileusMuconium ileus

Muconium ileusMuconium ileus

-solid muconium-solid muconium-15% of cyctic fibrosis 15% of cyctic fibrosis

-s/s: bilious vomiting ,distention ,no passing of -s/s: bilious vomiting ,distention ,no passing of meconiummeconium

Dx: FHx of CF, Xray ( air fluid levels- soap Dx: FHx of CF, Xray ( air fluid levels- soap bubble ) , enema ( microcolon)bubble ) , enema ( microcolon)

-Rx: non-surgical>>>Gastrografin enema & -Rx: non-surgical>>>Gastrografin enema & pancreatic enzymes replacement pancreatic enzymes replacement

If not surgically by ( enterotomy )If not surgically by ( enterotomy )

Muconium PlugMuconium Plug it is a major DDx of it is a major DDx of Hirchsprung’s DiseaseHirchsprung’s Disease

Colonic AtresiaColonic Atresia