intestinal obstruction in paeds
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INTESTINAL OBSTRUCTION IN PAEDSBy: Dr Ismah
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Presentation• Bile stained vomitus
• Delayed BO >24 hrs after born
• Colicky abdominal pain- Intermittent crying
• Abdominal distention
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Stomach outlet
Small intestine
Large intestine
• Vomiting severe, projectile
• Loss of electrolytes
• Dehydrated
• Vomiting less severe
• Loss of electrolytes and bile
• Dehydrated
• Very less vomiting
• Abdominal distention
• Fail to pass stool
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Ddx Neonates Infants Preschool
(<5 y/o)School-aged (>5 y/o)
A. Mechanical• Pyloric stenosis• Intestinal
atresia, stenosis• Malrotation• Volvulus• Abdominal wall
defects• Anorectal
anomalies• Incarcerated
hernia• Intussusception
B. Functional • Necrotizing
enterocolitis• Hirschsprung’s
disease• Septicaemia• Hypothyroidism
• Malrotation with midgut volvulus
• Intussusception (3months to 3years)
• Incarcerated hernia
• Intussusception
• Incarcerated hernia
• Perforated appendicitis
• IBD
• Intrinsic lesions such as polyps, masses or Merkel’s diverticulum
• Extrinsic compression from incarcerated hernia, perforated appendicitis or post-operative adhesions
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Intestinal atresia• Incidence 1:2700 births
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Double bubble sign
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Malrotation and volvulus • 1:500 births (US)
• Intestinal non rotation or incomplete rotation around the superior mesenteric artery
• Malrotation is often not evident until the baby experiences a twisting of the intestine known as a volvulus
• In the hands of experienced ultrasonographers, ultrasonography has been shown to be very sensitive (approximately 100%) in detecting neonatal malrotation
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In this upper GI series with abnormal results, the duodenum does not cross the midline, and the small bowel is present only in the right side of the abdomen
These 2 lower GI series show the cecum (arrows) in the right upper quadrant, indicative of malrotation
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Intussuseption • Telescoping of one portion of intestine to another
• 1:2000 births (US)
• Bloody jelly stool
• Nonoperative reduction with a therapeutic enema/air. Its contraindications are peritonitis and any evidence of perforation on plain x ray
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Barium enema shows intussusception in the descending colon
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General treatment• Fluid and electrolyte replacement
• NBM and NG tube decompression
• Early surgical consultation
• Indications for emergeny laparotomy• Malrotation with or without midgut volvulus• Pneumoperitoneum• Irreducible intussusception• Peritonitis
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Thank you