neonatal intestinal obstruction
TRANSCRIPT
Most common surgical emergency in neonates.
Management depends on timely diagnosis Needs radiological assessment Outcome excellent
HIGH INTESTINAL OBSTRUCTION proximal to ileum i.e. gastric ,duodenal & jejunal.
LOW INTESTINAL OBSTRUCTION distal ileum & colon.
Rare Usually distal AXR—gas filled stomach without distal
intestinal air. SINGLE BUBBLE SIGN. Can be dx antenatally on ultrasound.
Congenital failure of recanalization. Association with VATER/VACTERL & trisomy
21. Post-ampullary. Bilous vomitting.
Gastro duodenal distention but distal gases present.
On contrast– slow transit of contrast distally.
Failure of normal physloiogical herniation in embryo
Leads to narrow mesenteric attachment. Predisposes to rotation around superior
mesenteric vessels. If untreated bowel ischemia & infarction.
Intestinal ischemia during intra uterine life. Present with bilous vomitting & abdominal
distention.
Meconium plugs obstruct colon & distal small bowel.
Associated with cystic fibrosis. AXR– multiple distended gut loops. Contrast study—meconium plugs & micro
colon.
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.
Arrest of neuron migration to distal bowel before 12th week.
rectosigmoid-75% splenic flexure-20% whole colon-5%
Association with VATER High/low depending levator ani muscle Low –blind ending pouch. High-associated with fistula to
bladder,urethra & vagina.