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.

1. By;
Mr. Adeel ABBAS

2.  The First Sign of Life is Cry…

3.  Timely Passage Of The First Stool Is A Hallmark Of
The Well-being Of The Newborn Infant.

4.  Meconium is the First Stool Passed by New-Born.

5.  What is the Identity of Meconium?

6.  Meconium is;
 Thick.
 Sticky.
 Blackish-Green.

7.  Timming of Passing 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.

10.  FAILURE TO PASS MECONIUM…
 Is It A Problem?

11.  YES…
 Failure To Pass Meconium Is A Problem.

12.  Is Breathing Problems caused by Inhaling Meconium
Serious?

13.  Breathing Problems Caused By The Baby Inhaling
Meconium Are Usually Not Serious.

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.
What’s the Diagnosis?

15.  Diagnosis is Neonatal Intestinal Obstruction.

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.

18.  On the second day…

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.

23.  Compare . . .

24.  What’s Your Diagnosis?

25.  Diagnosis is;
 “ Hirschsprung's Disease “.

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  Enterocolitis.

28.  How Will You Proceed?

29.  Abdominal X-Ray…

30.  Barium Enema…

31. Day 1 6th Week Showing Transition Zone

32.  The Presence Of Barium In The 24-hour Delayed Film
Also Suggests Hirschsprung's Disease.

33.  Ano-Rectal Manometry…

35. TREATMENT
 Surgery… … …
 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.

38.  What is the Diagnosis?

39.  Hint:
 Contrast Enema Is Diagnostic, And Also Therapeutic …

40.  Meconium Plug Syndrome

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.

44.  What Is The Diagnosis?

45.  Meconium Ileus.

46.  What’s Most Common Underlying Cause of
Meconium Ileus?
 Cystic fibrosis …

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 
 Gastrografin Enema And
 Plenty Of Intravenous Fluids.

49.  If The Gastrografin Enema Is Unsuccessful…!...?
 Operative Evacuation Of The Obstructing Meconium By
Irrigation…

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 Anus…
 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.

52.  Treatment … ?

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.