This document discusses various types of intestinal obstructions in neonates. It describes high intestinal obstructions, which occur proximal to the ileum such as gastric, duodenal or jejunal obstructions. It also describes low intestinal obstructions, which occur distal to the ileum and in the colon. Specific causes of obstruction discussed include duodenal atresia, intestinal malrotation, necrotizing enterocolitis, meconium ileus and Hirschsprung's disease. Diagnosis involves abdominal x-rays and contrast studies to identify the location and cause of obstruction.

2.  Most common surgical emergency in
neonates.
 Management depends on timely diagnosis
 Needs radiological assessment
 Outcome excellent

3.  Refusal to take feed.
 Vomitting.
 Abdominal distention.
 Delayed/failure to pass meconium.

4.  HIGH INTESTINAL OBSTRUCTION
proximal to ileum i.e. gastric ,duodenal
& jejunal.
 LOW INTESTINAL OBSTRUCTION
distal ileum & colon.

6. HIGH INTESTINAL OBSTRUCTION

7.  Rare
 Usually distal
 AXR—gas filled stomach without distal
intestinal air. SINGLE BUBBLE SIGN.
 Can be dx antenatally on ultrasound.

11.  Congenital failure of recanalization.
 Association with VATER/VACTERL & trisomy
21.
 Post-ampullary.
 Bilous vomitting.

12.  On AXR gas filled distended stomach &
duodenal cap.
 Absent distal bowel gases,

18.  Gastro duodenal distention but distal gases
present.
 On contrast– slow transit of contrast distally.

21.  Small congenital obstructive membrane with
central aperture.

23.  Failure of normal physloiogical herniation in
embryo
 Leads to narrow mesenteric attachment.
 Predisposes to rotation around superior
mesenteric vessels.
 If untreated bowel ischemia & infarction.

27.  Abnormal course of duodenum that fail to
cross midline has spiral appearance .

31.  Intestinal ischemia during intra uterine life.
 Present with bilous vomitting & abdominal
distention.

32.  Distention of stomach ,duodenum &
jejunum.

35. LOW INTESTINAL OBSTRUCTION

36.  Due to intra uterine ischemic insult.
 Bilous vomiting & distention.
 Numerous dilated bowel loops.

39.  Meconium plugs obstruct colon & distal small
bowel.
 Associated with cystic fibrosis.
 AXR– multiple distended gut loops.
 Contrast study—meconium plugs & micro
colon.

43.  Meconium plug /small left colon syndrome.
 Benign & self limiting condition.
 Due to immaturity of colonic ganglion cells.
 To infants of diabetic mothers & those who
took MgSO4 for pre eclampsia.

44.  Contrast studies-
dilated ascending & transverse colon
small descending colon
rectum normal

47.  Arrest of neuron migration to distal bowel
before 12th
week.
rectosigmoid-75%
splenic flexure-20%
whole colon-5%

48.  Affected segment narrowed.
 Proximal dilatation.

52.  Rarely an uncommon condition
 Intra uterine vascular insult
 Proximal to splenic flexure

55.  Association with VATER
 High/low depending levator ani muscle
 Low –blind ending pouch.
 High-associated with fistula to
bladder,urethra & vagina.