HIGH INTESTINAL OBSTRUCTION LOW INTESTINAL 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.