Intestinal Obstruction in Newborns

Posted by e-Medical PPT Monday, August 12, 2013
Differential Diagnosis in neonate with abdominal distention and Constipation
Meconium Ileus
Distal jejuno-ilealatresia
Hirschsprung’sDisease

Intestinal Atresia
Congenital obstruction caused by complete occlusion of intestinal lumen
Mesenteric vascular accidents in utero
Multifactorial
Incidence:
Jejunoileal: 1 in 330 (US)-1 in 1500
Increased in maternal use of pseudoephedrine and ergotamine + caffeine

Symptoms:
Bilious emesis-proximal
Abdominal distention-distal
Maternal polyhydramnios(24%)
Failure to pass meconium

Prenatal Ultrasound
More detectable in duodenal atresia
Multiple distended loops of bowel with vigorous peristalsis
Echogenic bowel
<1/3 cases recognized

Intestinal Atresia Classifications
Type I: mucosal atresia with intact bowel wall and mesentary
Type 2: 2 atreticblind ends joined by fibrous cord + intact mesentary
Type 3:
A-two ends of atresia separated by V shaped mesenteric defect
B-“Christmas tree” deformity
Bowel distal to the atresia receives its blood supply in a retrograde fashion from ileocolicor right colic artery
Type 4-mutlipleatresias
“String of sausage” or “string of beads”

Operative Interventions
In proximal jejunalatresia-resection at ligament of Treitzfollowed by end –to-oblique anastamosis
If limited length-tapering enteroplasty
Retention of dilated blind proximal segment-functional obstruction
Smooth muscle hypertrophy and enlargement of bowel diameter
Ineffective peristalsis

Morbidity and Mortality
Most common cause of early death: infection related to pneumonia, peritonitis or sepsis
Postoperative complications:
Functional intestinal obstuctionat anastamosis
Anastamoticleak (15%)
De Lorimierand associates concluded that resection improved survival in jejunalatresia from 39% to 66%.
Little effect on overall survival in ilealatresia
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