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INTESTINAL OBSTRUCTION IN PAEDSBy: Dr Ismah

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Presentation• Bile stained vomitus

• Delayed BO >24 hrs after born

• Colicky abdominal pain- Intermittent crying

• Abdominal distention

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Stomach outlet

Small intestine

Large intestine

• Vomiting severe, projectile

• Loss of electrolytes

• Dehydrated

• Vomiting less severe

• Loss of electrolytes and bile

• Dehydrated

• Very less vomiting

• Abdominal distention

• Fail to pass stool

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Ddx Neonates Infants Preschool

(<5 y/o)School-aged (>5 y/o)

A. Mechanical• Pyloric stenosis• Intestinal

atresia, stenosis• Malrotation• Volvulus• Abdominal wall

defects• Anorectal

anomalies• Incarcerated

hernia• Intussusception

B. Functional • Necrotizing

enterocolitis• Hirschsprung’s

disease• Septicaemia• Hypothyroidism

• Malrotation with midgut volvulus

• Intussusception (3months to 3years)

• Incarcerated hernia

• Intussusception

• Incarcerated hernia

• Perforated appendicitis

• IBD

• Intrinsic lesions such as polyps, masses or Merkel’s diverticulum

• Extrinsic compression from incarcerated hernia, perforated appendicitis or post-operative adhesions

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Intestinal atresia• Incidence 1:2700 births

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Double bubble sign

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Malrotation and volvulus • 1:500 births (US)

• Intestinal non rotation or incomplete rotation around the superior mesenteric artery

• Malrotation is often not evident until the baby experiences a twisting of the intestine known as a volvulus

• In the hands of experienced ultrasonographers, ultrasonography has been shown to be very sensitive (approximately 100%) in detecting neonatal malrotation

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In this upper GI series with abnormal results, the duodenum does not cross the midline, and the small bowel is present only in the right side of the abdomen

These 2 lower GI series show the cecum (arrows) in the right upper quadrant, indicative of malrotation

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Intussuseption • Telescoping of one portion of intestine to another

• 1:2000 births (US)

• Bloody jelly stool

• Nonoperative reduction with a therapeutic enema/air. Its contraindications are peritonitis and any evidence of perforation on plain x ray

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Barium enema shows intussusception in the descending colon

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General treatment• Fluid and electrolyte replacement

• NBM and NG tube decompression

• Early surgical consultation

• Indications for emergeny laparotomy• Malrotation with or without midgut volvulus• Pneumoperitoneum• Irreducible intussusception• Peritonitis

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Thank you