NEONATAL LOWER INTESTINAL OBSTRACTION

Lower GI Obstraction

Distal Obstruction

Signs of Intestinal Obstruction: 1- pain>colic 2-vomiting >depend on the level 3-distention> the distal the obstruction the more the distention 4-absolute constipation > early in large bowel & late in small bowel .

Hirchsprung’s Disease

Barium Enema

-common in males -recto-sigmoid is most common -s/s:failure to pass meconium in the 24h of life( imp) ,abdominal distention ,bilious vomiting In older children> constipation Dx: xray >dilated colon PR> gush of stools unprepared enema> retention of barium Biopsy (gold one) -Rx:- resuscitation - pull through procedure ( can be done after colostomy)

Anorectal Malformation Cutaneous fistula rectourethral fistula

Cutaneous fistula

recto-vistibular fistula

ARM( invertogram) Invertogram Cross table

ARM(rectal gas)

Distal Loopogram Recto urethral Fistula

Colostomy PSARP

-It can be high or low type according to puborectalis -low> female > recto-vistibular fistula -high> male> recto vasical -associated with VACTERL -s/s:no anus ,fistula, UTI, bowel obstruction. -Dx: physical examination ( the imp) cross table invertogram xray> for rectal gas US

Rx: Low type with fistula>>repair the fistula & anoplasty High type>>colostomy then anoplasty

X-Ray Muconium ileus

Muconium ileus

Muconium ileus

-solid muconium 15% of cyctic fibrosis -s/s: bilious vomiting ,distention ,no passing of meconium Dx: FHx of CF, Xray ( air fluid levels- soap bubble ) , enema ( microcolon) -Rx: non-surgical>>>Gastrografin enema & pancreatic enzymes replacement If not surgically by ( enterotomy )

Muconium Plug it is a major DDx of Hirchsprung’s Disease

Colonic Atresia