The document discusses various causes of neonatal intestinal obstruction including meconium ileus, meconium plug syndrome, Hirschsprung's disease, and anal atresia. It provides details on the presentation, diagnosis, and treatment of each condition. For example, it notes that meconium ileus presents at birth with abdominal distension and vomiting and is often associated with cystic fibrosis. Diagnosis is typically made through contrast enema and treatment may involve gastrografin enema or surgery to evacuate the obstructing meconium.
8. ๏ In Full-term?
๏ 99% Pass Within 24 Hours.
๏ All Pass Within 48 Hours.
๏ In Pre-term?
๏ 37% Pass Within 24 Hours.
๏ All Pass Upto 9 Days.
9. ๏ Failure Of A Full-term Newborn To Pass Meconium
Within The First 24 Hours Should Raise A Suspicion
Of Intestinal Obstruction.
14. Clinical Presentation
๏ A 3.5 Kg male infant was born after 40 weeks' gestation.
There were no complications during the pregnancy and
delivery. He did not pass meconium after birth, and he
had the onset of bilious vomiting. His abdomen is
distended, with palpable loops of bowel. The infant was
not able to feed.
Whatโs the Diagnosis?
16. Differential Diagnosis (of I. Obs:)
๏ Duodenal Atresia,
๏ Malrotation And Volvulus,
๏ Jejunoileal Atresia,
๏ Meconium Ileus And
๏ Meconium Peritonitis.
17. Clinical Presentation
๏ A 3.5 Kg Male Infant Was Born After 40 Weeks' Gestation.
There Were No Complications During The Pregnancy &
Delivery. He Did Not Pass Meconium After Birth, & He Had
The Onset Of Vomiting On The First Day. His Abdomen
Became Mildly Distended. The Infant Was Not Able To
Feed, And Abdominal Distention Increased.
๏ DRE reveals Tight Anus.
19. ๏ The Surgeon Performed An Anal Dilatation.
๏ The Infant Subsequently Passed Gas And Meconium.
20. ๏ After Discharge From The Hospital, The Infant's
Mother Continued Performing Periodic Anal
Dilatation Because He Had Difficulties Moving His
Bowel.
21. ๏ Digital Rectal Examination By The Physician When
The Infant Was Five Weeks Of Age Revealed A Tight
Anus And Liquid Stool But No Impaction.
22. ๏ One Week Later, The Mother Noticed A Bloody Bowel
Movements.
26. Hirschsprung's Disease
๏ Congenital Aganglionic Megacolon.
๏ Overall Incidence Of 1 In 4,000 Live Births.
๏ 20 To 25% Of The Cases Of Neonatal Bowel
Obstruction.
๏ Male to Female Ratio 4:1.
๏ 8% Have Down Syndrome.
27. ๏ Common Presentation Of Hirschsprung's Disease;
๏ Newborn.
๏ Failure To Pass Meconium During The First Few Days Of
Life.
๏ Subsequent Passage Of A Meconium Plug Followed By
Sparse Bowel Movements.
๏ Gastrointestinal Bleeding And Diarrhea Are DANGER
SIGNS ๏จ Enterocolitis.
35. TREATMENT
๏ Surgeryโฆ โฆ โฆ
๏ To Remove Or Bypass The Diseased Bowel.
๏ Initially Colostomy.
๏ Corrective Surgery In Three To Six Months.
36. Clinical Presentation
๏ A 3.5 Kg Male Infant Was Born After 40 Weeks' Gestation.
There Were No Complications During The Pregnancy &
Delivery. He Did Not Pass Meconium After Birth, & He Had
The Onset Of Vomiting On The First Day. His Abdomen
Became Mildly Distended. The Infant Was Not Able To
Feed, And Abdominal Distention Increased.
๏ DRE reveals Normal Anus.
41. Meconium Plug Syndrome
๏ Mildest & Most Common Form Of Functional Distal
Obstruction In The Newborn.
๏ Obstruction Caused By Inspissated, Immobile
Meconium.
๏ Incidence 1 Case In 500 To 1,000 Neonates.1
๏ Etiology Is Unclear.
42. Clinical Presentation
๏ A 3.5 Kg Male Infant Was Born After 40 Weeks' Gestation.
There Were No Complications During The Pregnancy &
Delivery. He Did Not Pass Meconium After Birth.
Abdominal Distention Is Present At Birth. Within Hours,
The Distention Increases, & The Infant Vomits Bile-stained
Material. Bowel Loops Are Visible Through The Abdominal
Wall. Rectal Examination Is Difficult.
46. ๏ Whatโs Most Common Underlying Cause of
Meconium Ileus?
๏ Cystic fibrosis โฆ
47. ๏ Cystic Fibrosis Is The Underlying Disorder In 95%
Infants With Meconium Ileus.
๏ Meconium Ileus Occurs In 15% Of Patients With
Cystic Fibrosis.
48. Treatment ?
๏ Simple Meconium Ileus ๏จ
๏ Gastrografin Enema And
๏ Plenty Of Intravenous Fluids.
49. ๏ If The Gastrografin Enema Is Unsuccessfulโฆ!...?
๏ Operative Evacuation Of The Obstructing Meconium By
Irrigationโฆ
50. Clinical Presentation
๏ A 3.5 Kg Male Infant Was Born After 40 Weeks' Gestation.
There Were No Complications During The Pregnancy &
Delivery. He Did Not Pass Meconium After Birth. Within
Hours, The Distention Increases. Perineal Inspection
Reveals The Absent Anusโฆ
๏ What Is The Diagnosis?
51. ๏ High Type..?
๏ Rectum Ends Above The Levator Muscle.
๏ Low Type..?
๏ Rectum Partially Descends Through Levator Muscle.
๏ Often, The Rectum Ends In A Fistula.
53. ๏ Anal Atresia Requires Surgery.
๏ Goal Of Surgery Is To Preserve Bowel, Urinary &
Sexual Function.
54. ๏ Colostomy Is Initially Performed In Neonates With
High Anal Atresia.
๏ Followed by Elective Pull-Through Surgery.
55. ๏ Fistula Can Be Gently Dilated To Allow The Gas &
Meconium To Pass.
๏ Fistula Can Be Corrected Electively When The Infant's
Condition Is Stable.