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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
Hirshsprungs disease
Anorectal malformation
small colon syndrome
:
Pyloric stenosis

Extremely rare in the neonates
3
rd
8
th
week
Usually 1
st
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 Downs syndrome( 30%) &
congenital heart disease.
Due to failure of recanalization after the 6
th
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 Downs
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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