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Neonatal Intestinal Obstruction (Nuha Khwaja)

This document discusses several types of neonatal intestinal obstructions including pyloric stenosis, congenital duodenal obstruction, small intestinal atresia, and Hirschsprung's disease. It describes the symptoms, diagnostic process, and surgical treatment for each condition. Pyloric stenosis presents with projectile vomiting in infants and is treated with pyloromyotomy. Duodenal atresia is diagnosed using imaging and treated with duodenoduodenostomy or duodenojejunostomy. Small intestinal atresia is also surgically repaired with an end-to-end anastomosis.

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127 views21 pages

Neonatal Intestinal Obstruction (Nuha Khwaja)

This document discusses several types of neonatal intestinal obstructions including pyloric stenosis, congenital duodenal obstruction, small intestinal atresia, and Hirschsprung's disease. It describes the symptoms, diagnostic process, and surgical treatment for each condition. Pyloric stenosis presents with projectile vomiting in infants and is treated with pyloromyotomy. Duodenal atresia is diagnosed using imaging and treated with duodenoduodenostomy or duodenojejunostomy. Small intestinal atresia is also surgically repaired with an end-to-end anastomosis.

Uploaded by

dtalks andyou
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NEONATAL INTESTINAL

OBSTRUCTION
Noha Al-khawaja
Maram Al-zein
Amani Azeez Alrahman
SUPERVISOR:Dr.Aayed Al-Qahtani
Neonatal intestinal obstruction
• Can be grouped into high & low intestinal
obstructions:
High obstructions:
• Pyloric obstruction
• Duodenal obstruction: complete - partial
• Very proximal Jejunal obstruction
Low obstructions:
• Small bowel obstruction
• Meconium ileus & meconium plug
• Colonic atresia
• Hirshsprung’s disease
• Anorectal malformation
• small colon syndrome
Pyloric stenosis
• Extremely rare in the neonates
• 3rd – 8th week
• Usually 1st born male child
• History: Present with non bilious projectile vomiting that
becomes progressively worse, weight loss & dehydration
• Examination: Peristaltic waves may be seen, palpable
hard mass in the epigastrium
• Investigations: CBC, urea & electrolytes ,US{ thickness ,
diameter ,& length of pylorus}. If equivocal do barium swallow
• Treatment: NG tube, NPO, correct dehydration.
pyloromyotomy.
CONGENITAL DUODENAL
:OBSTRUCTION
Types:
• Duodenal atresia
• Duodenal stenosis
• Duodenal web
• Annular pancreas
• Malrotation
Incidence:
• 1 in 10000 to 40000 births
Pathology:
Failure of canalization,vascular accidents,& arrest of normal
pancreatic development.
:Duodenal atresia
• 1 in 5000 live births
• May be associated with Down’s syndrome( 30%) &
congenital heart disease.
• Due to failure of recanalization after the 6th week of
gestation.
History & examination:
• History of maternal polyhydramnious.
• Bilious vomiting.
• Pass meconium.
• On examination:
- visible gastric peristaltic waves.
-stomach may be palpable.
-diffuse abdominal distention is not characteristic.
:Investigations
• Antenatal diagnosis with
US
• CBC.
• Urea and electrolytes
• Abdominal x-ray shows
double bubble sign
• Echocardiography
• Some recommend a
routine karyotype in
neonates born with
duodenal obstruction
MANAGEMENT
• NPO
• Nasogastric tube.
• IV fluids, antibiotics (Ampicillin – Gentamicin)
• Goals are:
~restoration of continuity without sacrificing
intestinal length or absorpative area
~avoidance of injury to the pancreas or ampulla of
vater
• Best approach is duodenoduodenostomy
duodenojejunostomy reserved for obstructing lesions in
the distal duodenum
:Results
• Neonates require a period of several weeks before
entral feeding is tolerated
• Surgical outcome is excellent
• Mortality is confined to neonates with Down’s
syndrome and congenital heart disease
• Duodenal stenosis
• Duodenal web
• Annular pancreas :
~ characterised by
circumferential persistence of
the gland around the
duodenum at the site of the
embryonic ventral pancreatic
diverticulum
~associated with intrinsic
duodenal obstruction and a
patent accessory pancreatic
duct
Symptoms & Signs
• Same presentation
• However, many produce few symptoms
• Diagnostic delay later in life is relatively
frequent
• Abdominal radiograph shows double
bubble sign with some gas distally.
Management
• Same preoperative preparation
• Excision of duodenal web
• Duodenoduodenostomy
Small intestinal atresia
• Occurs secondary to in utero ischemic insult
• Overall distribution is roughly equal between
jejunum & ileum
• 90% of infants with congenital jejunoileal
obstructions have atresia
• More than one atresia is reported in 6% to 20%
of these infants
• Low incidence of significant associated anomalies
< 10%
Types of Atresia
• Type I  a single
membranous atresia, with
continuity of the bowel
wall and intact mesentry

• Type II single atresia


with discontinuity of the
bowel wall
• Type IIIa  atresia without connection by a fibrous cord ,
with a mesenteric gap
• Type IIIb  apple-peel mesentery or christmas_tree
atresia of a large segment of bowel and mesentery
the proximal part is dilated
the distal segment is collapsed & spiraled about distal
branches of ileocolic artery
• Type IV  multiple atresias
intussusception ,segmental volvolus ,or thromboembolism
could be the causes
History and Examination
• Maternal history of polyhydramnious ( 25% of ileal )
• Bilious vomiting ,abdominal distention.
• Failure to Pass meconium.
• Signs of dehydration .
• Palpable individual loops of proximal intestine.
Investigations
• CBC, Urea and electrolytes.
• Plain x-ray:
~marked distention of proximal intestinal loops
with gasless distal small bowel & colon
~in ileal atresia multiple dilated loops of bowel
,with multiple air fluid levels
• Contrast enema: because haustral markings are
not normally apparent in neonatal colon it
cannot be differentiated from small bowel.
Management
• NPO, IV fluids ,NG Tube, antibiotics
• Via a supraumblical incision simple end to end
anastomosis & short segmental bowel resection
• Multiple atresias may require multiple
anastomoses .
:Results
• Incidence of anastomotic problems as leak is
nearly 5% to 10%.
• Prolonged dysfunction of the proximal gut for
days or weeks is common.
• Morbidity & mortality are generally limited to
those with heart disease,prematurity,or other
associated problems.

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