Neonatal Intestinal Obstruction

1. Neonatal GI obstruction

2.  General Symptoms:
-Bilious or nonbilious vomiting
-Abdominal Distension
-Failure to pass meconium
 Surgical Causes:
1. Mechanical (Dynamic)
a) Extramural
1) Malrotation and Ladd’s band
2) Volvulus
3) Duplication
4) Diaphragmatic Hernia
5) Intussusception
b) Mural
-Atresia
c) Intraluminal:
-Meconium Ileus
-Meconium Plug
2. Adynamic
- Hirschsprung’s Disease
- hypothyroidism
- NEC
- sepsis
- electrolytes imbalance

3. Neonatal GI Obstruction
Classified in relation to the mid portion of the jejunum
1- High anatomical obstruction
1- Esophageal atresia
2-Pyloric stenosis
3-Duodenal obstruction :
Atresia
Annular pancreas
Ladd's band
Mal rotation ± Volvulus
4-Proximal jejunal atresia
5-Intestinal duplication
6-Inernal herniation.

4. 2- Low anatomical obstruction
1-Ileal atresia or Stenosis
2-colonic atresia or Stenosis
3-Meconium ileus
4-Hirschsprung's disease
5-Meconium plug syndrome
6-Intussusception
7-Anorectal malformations , Imperforate anus.
8-Intestinal duplication
9-Inernal herniation.

5. Functional obstruction
1-Sepsis
2-Electrolyte imbalance
3-Necrotising enterocolitis (NEC)
4-hypothyroidism.

6. Symptoms of neonatal intestinal
obstruction
Vomiting
 The onset , character and severity of the vomiting is
dependent on the cause of the obstruction.
 Bilious vomiting  obstruction distal to the ampulla of
vater

7. Failure to pass meconium :
 within the first 24 hours
 With proximal lesion neonate may pass some meconium ,
but fail to pass subsequent stool
 With incomplete obstruction the neonate may pass little
amount of meconium
 In case of imperforate anus meconium may be passed per
urethra or per vigina.
Abnormal findings in the stool :
 Bleeding per-rectum indicate a possible volvulus , NEC or
intussusception.
Abdominal distention :
 Common
 The more the distal the obstruction the more is the severe
distention.

8. Physical examination (Signs)
 Signs of dehydration
 Abdominal distension
 Tenderness and guarding ; Peritoreal signs are often
present in cases of volvulus , NEC , perforation and
ischemia
Abdominal wall erythema is also consistent with peritonitis
 Palpable mass in the RUQ and empty RLQ in
intussusception
 Examine the anus and the rectum for anomalies

9. Investigations
CBC, KFT, ABG
Radiological examination:
Supine and erect x-ray
difficult to differentiate small from large bowel
obstruction before the first year of age.

10. Treatment of mechanical intestinal
obstruction
(General Guidelines)
Preoperative
1. NG tube
2. IV fluids
3. Correction of electrolytes and acid base imbalance
4. Antibiotics.
Operative
Laparotomy and dealing surgically with the underlying cause if
necessary
Postoperative
In the Neonatal ICU

11. Duodenal atresia
 Failure of recanalization of the lumen
 A/W polyhydramnios
 Bilious vomiting
 Double bubble sign on x-ray
 30% have Down syndrome
 8% of Down have duodenal atresia

12. Treatment
• NG, IVF, correct electrolytes
and acid-base imbalance
• Surgery:
- Duodeno-duodenostomy
(most common)
- Duodeno-jejunostomy

13. 
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