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

2. Sequence
Duodenal Atresia
Jejuno-ileal Atresia
Meconium Ileus

3. 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

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

5. 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

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

7. Association

8. 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

10. Investigations

11. Management
NPO
Nasogastric aspiration
Intravenous fluids
Antibiotics
Surgery

12. 5’ Hs
Hypothermia
Hypoxia
Hypovolemia
Hypoglycaemia
Hypoprothrombinaemia

13. Management

14. Management

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

17. 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

18. Types

19. Types

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

21. Investigations

22. Management

23. Management

24. 30 % intestinal obstruction Associated Anomalies
Meconium Ieus
30 % intestinal obstruction
Associated Anomalies
Cystic Fibrosis 15%
Atresia
Malrotation

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

26. Investigations

29. Hypertonic Enema Washouts
Treatment
Hypertonic Enema Washouts
Gastrograffin %
Effective % cases
N-Acetyl cysteine 10 %

30. Management