Small Intestine Obstruction (Pediatrics)



There are several causes of small intestine obstruction:


 * Atresia – the intestine ends with blind end and after variably long atresic part, the distal part is opened. May be caused by intrauterine vessel malfunction of the intestine with subsequent gangrene. Gangrene is then resorbed and atresia develops.
 * Meconium ileus – obstruction caused by meconium.
 * Some cases of Hirschprung's disease (megacolon congenitum) may affect small intestine.
 * Extraintestinal causes – malrotation, collagen dysfunctions, hernia, calcificated lymphatic nodes, duplicatures, omphalocela.



Duodenum obstruction

 * Part of so called proximal type of duodenal obstruction – characterized by – smaller abdominal distension and permanent explosive vomiting.


 * Obstruction under the level of 15 cm from the jejunum – distal obstruction – hyperinflation of the abdomen, abdominal distension, vomiting comes later.


 * Duodenal obstruction may be caused by atresia (more often) or stenosis.


 * More often in Down's syndrome and undeveloped children.


 * Obstruction is usually under papilla duodeni major (Vater's papilla).


 * Obstruction may also developed during intestinal malrotation, volvulus congenitalis or pancreas anulare.


 * Klinický obraz:


 * Obstruction of duodenum is strongly connected to circulation of amniotic fluid – in every case of obstruction we lated find outpolyhydramnion.


 * Every time we find polyhydramnion, there is a post-partum nasogastric sond indicated to remove any gastric contents – if more than 15 ml, proximal intestinal obstruction is suspected.


 * Main symptom – 'projectile' vomiting (in case of atresia quickly develops after the birth, with stenosis a few hours later).


 * Vomits have yellow color due to the bile contents.


 * There may be seen peristaltic wave similar during pylorstenosis.


 * Distension – only in epigastrium or none.


 * Laboratory findings – hypochloremic alkalosis, Na+ and K+ depletion;
 * when vomiting is chronic,MAl may be transfered intoMAc and acidobasis dysfunction is even worse.
 * Diagnosis – may be diagnosed with USG prior to birth.
 * Post-partum, X-ray screening in hanging position (contrast coloring is thanks to the air that the baby swallows) when the child is borned.
 * Physiologically – immediately after the birth, there is an air in the stomach, within 1 hour in small intestine, 4–18 h in colon.
 * In atresia there is a characteristic finding of „two bubbles“ – one in stomach, second in duodenum.
 * Therapy – surgical – duodenoplasty, duodenojejunostomy,
 * Prior to the surgery, acidobasis laboratory findings has to be corrected.

related articles

 * congenital atresias and stenosis of gastrointestinal tracts
 * Pylorostenosis congenita
 * superior mesenteric artery syndrom
 * bowel malrotaion and volvulus
 * Meconium ileus
 * Megacolon congenitum
 * Ladd syndrom