some causes of neonatal intestinal obstruction fore undergraduate medical student

1. Neonatal intestinal
obstruction
MAGDI LOULAH
PROFESSOR OF PEDIATRIC SURGERY, MENOUFIA UNIVERSITY0

2. Duodenal obstruction
 Duodenal atresia
 Type 1, type 2, type 3
 Annular pancreas
 Ladd’s bands

3. A- Duodenal
atresia
B- Windsock
C- Duodenal
atresia

4. Windsock anomaly

5. Annular pancreas

6. Malrotation and Ladd’s band

7. Etiology & Incidence
 Most cases of duodenal atresia are sporadic.
 The incidence of duodenal atresia is 1 case per 5000-10,000 live births.

8.  Antenatal diagnosis by US.
 Polyhydramnios
 Persistent vomiting (Non bilious, Bilious)
 Upper abdominal distention
 Some infants pass little meconium

9. diagnosis
Plain X-Ray
Double Bubble appearance

11. Surgical treatment

12. Neonatal intestinal
atresia
Type 1: Atresia
Type 2: Atresia with cord like
band between the two ends
Type 3a: Atresia with a V shaped
mesenteric defect
Type 3b: Apple peel anomaly
Type 4: Multiple intestinal atresia

13. Diagnosis
Clinical features: persistent bile
stained vomiting, abdominal
distension, and non passage of
meconium.
Plain x-ray
Barium enema: microcolon

14. Intestinal malrotation and volvulous
 The alimentary tract develops from the
embryologic foregut, midgut, and
hindgut. Normal rotation takes place
around the superior mesenteric artery
(SMA) as the axis. It is described by
referring to 2 ends of the alimentary
canal, the proximal duodenojejunal loop
and the distal cecocolic loop, and is
usually divided into 3 stages. Both loops
make a total of 270° in rotation during
normal development. Both loops start in
a vertical plane parallel to the SMA and
end in a horizontal plane. See the image
below.

16. Types
- Non rotation
- Incomplete rotation
- Incomplete fixation
Incidence
- 1:200-500
- Symptomatic cases
1:5000
- Male to Female 2:1
Clinical presentation
- Acute midgut volvulus
- Chronic midgut volvulus
- Acute duodenal
obstruction
- Chronic duodenal
obstruction
- Internal herniation

17. Diagnosis
- Serum electrolytes
- Hematocrit
- Karyotyping
- Blood glucose& Bl. Group
- Gastrotropin meal and
follow through.
- Abdominal U/S
- Echocardiography

18. Treatment
The treatment is surgical
through abdominal
exploration and Ladd’s
procedure:
- Untwisting of any
volvulous
- Division of any
abnormal bands
- Placement of the small
intestine in the right
side
- Placement of the large
intestine in the left side
- Appendicectomy

20. Meconium ileus
- Meconium ileus refers to
an intraluminal intestinal
obstruction produced by
thick inspissated
meconium.
- Ninety percent of patients
with meconium ileus have
cystic fibrosis (CF). Indeed,
in 10% to 15% of cases of
CF, the patient presents
with meconium ileus.
- Incidence: 9% : 33 % of
neonatal small intestinal
obstruction.
- Clinical features
- Diagnosis: X ray, Contrast
Enema, IRT
- Treatment: Medical,
Surgical

21. Bishop-Koop ileostomy

22. Best wishes