INTESTINAL OBSTRUCTION By: Brig Mushahid Aslam “Neither sun shall rise nor set on patient of intestinal obstruction”

Sequence Duodenal Atresia Jejuno-ileal Atresia Meconium Ileus

Definitions Agenesis absence of organ or primordium Aplasia absence of organ due to failure of primordium Atresia absence of an opening Hypoplasia incomplete development of an organ Hyperplasia overdevelopment of an organ Dysplasia abnormal cell organization

Duodenal Atresia 1: 5000 Associated Anomalies Down’s Syndrome 30 % Congenital Heart Diseases Malrotation Anorectal Malformations

complete loss of that region Congenital Atresia of the Small Intestine “Vascular Accidents” blood supply to a region of the bowel is compromised and a segment “dies”, resulting in narrowing or complete loss of that region 50% a region of the bowel is lost 20% a fibrous cord remains 20% narrowing, with a thin diaphragm separating the larger and smaller pieces of bowel N.B. stenoses (5%) and multiple atresias (5%) account for the remaining defects

Presentation Antenatal Newborn USG Feeding Intolerance Polyhydramnios Distended stomach and 1st part Duodenum Newborn Feeding Intolerance Bilious Vomiting Scaphoid Abdomen Failure to pass Meconium

Association

Types Type I： Complete membrane obstructing the lumen Type III： blind-ending pouch with no connection to the distal duodenum Type II： A pouch with a fibrous cord connecting to the distal duodenum

Investigations

Management NPO Nasogastric aspiration Intravenous fluids Antibiotics Surgery

5’ Hs Hypothermia Hypoxia Hypovolemia Hypoglycaemia Hypoprothrombinaemia

Management

Management

Jejuno-ileal Atresia 1/2000 Vomiting Abdominal Distension Failure to pass meconium

Pathogenesis Mesenteric vascular accidents during early embryologic development  infarction  organization + resorption of the necrotic segment The bowel segment distal to the atresia may contain meconium, indicating previous continuity of the intestine

Types

Types

CONGENITAL MIDGUT ATRESIA Types “APPLE PEEL” ATRESIA CONGENITAL MIDGUT ATRESIA

Investigations

Management

Management

30 % intestinal obstruction Associated Anomalies Meconium Ieus 30 % intestinal obstruction Associated Anomalies Cystic Fibrosis 15% Atresia Malrotation

Presentation Newborn Feeding Intolerance Bilious Vomiting Abdominal Distention Failure to pass Meconium

Investigations

Hypertonic Enema Washouts Treatment Hypertonic Enema Washouts Gastrograffin 25-50 % Effective 30-60 % cases N-Acetyl cysteine 10 %

Management