Intestinal obstruction in a newborn. Congenital intestinal obstruction. Acute and chronic

P76.9 Intestinal obstruction in newborn, unspecified

Epidemiology

Distribution statistics indicate that intestinal obstruction is a common disease - about 10% of the structure of acute abdominal diseases is occupied by this pathology. In 0.1 - 1.6% it complicates the course of the postoperative period in sick children who have undergone surgery on the abdominal organs in the neonatal period. The pathology is somewhat more common in boys. The mortality rate for this pathology ranges from 5 to 30% and strongly depends on the gestation and age of the newborn. If acute intestinal obstruction occurs in the early postoperative period, it reaches 16.2 - 60.3%, and depends on timely diagnosis and timing of surgical treatment.

Causes of intestinal obstruction in newborns

Intestinal obstruction is a syndrome that complicates the course of many diseases and conditions. The pathophysiological link is a violation of the movement of chyme along the digestive canal, which in turn completely or partially disrupts the motor function of the intestine. There can be many reasons for this, but disruption of normal intestinal function is one of the most important factors.

To understand all the reasons for the development of obstruction, you need to know some types of this pathology. There are strangulation, obstructive, spastic and paralytic obstruction. Accordingly, there are different reasons for this.

Obstructive obstruction occurs as a result of coprostasis or intestinal tumors, which is much less common in newborns. Coprostasis is caused by congenital Hirschsprung's disease, colon stenosis, which is accompanied by intestinal atony. This makes contraction and intestinal motility difficult even from the very birth of the baby. This leads to the fact that such children suffer from constipation, and coprolites (small fecal stones) are formed from feces. Such coprolites can completely obstruct the lumen of the intestinal tube and cause intestinal obstruction.

Strangulated intestinal obstruction develops against the background of Meckel's diverticulum, internal hernias, especially clinically significant diaphragmatic hernias. Such pathologies often lead to increased intestinal motility, and especially in newborns, the intestinal mesentery is very mobile. This easily leads to pinching of the intestinal wall and some external strangulation occurs.

The most common causes of intestinal obstruction in newborns are diseases of other organs. They underlie the so-called paralytic obstruction. The reasons for this may be the following:

medications, especially drugs that affect the intestinal muscle wall;
an infection of the abdominal cavity weakens not only motility, but also other intestinal functions;
mesenteric ischemia due to congenital pathologies of the vessels of the descending aorta or mesenteric arteries;
complications of abdominal surgical interventions;
diseases of the kidneys and chest organs;
metabolic disorders (hypokalemia);
necrotizing enterocolitis in newborns;

Often such obstruction occurs against the background of birth trauma, functional immaturity of the digestive tract, pneumonia, sepsis, and peritonitis. These pathologies cause a reaction of internal organs in the form of centralization of blood circulation, which causes ischemia of the intestinal wall. Peristalsis is also impaired due to intoxication, especially in newborns due to the immaturity of the mechanisms for coordinating this function. This leads to intestinal paresis and subsequent development of obstruction.

Intussusception is distinguished separately, since with this type of obstruction there are elements of obstruction and strangulation. Intussusception is a special type of acquired obstruction in young children, the essence of which is that the proximal segment of the intestine is wedged into the distal one. Subsequently, the blood supply to the intestine is disrupted, which leads to its necrosis.

There are small-small intussusception, ileocecal type (90%), very rarely large-colic (1-3%) intussusception. In the area where intussusception occurs, a tumor-like formation is formed, which consists of three layers of the intestinal wall: the outer, into which the intussusception is wedged, the middle and the inner. The mesentery of the intestine is pinched between these walls of the intussusception. The clinical course of the disease depends on the degree of entrapment - with mild entrapment, the symptoms of the obstructive process predominate, the disease proceeds easily, and intestinal necrosis does not occur. In cases of severe strangulation, signs of strangulation intestinal obstruction predominate, bloody stools and necrosis of the intussusception quickly appear. Ileocecal intussusception occurs more easily than small-intestinal intussusception. After the phase of venous stagnation, as a rule, swelling quickly increases, stagnant bleeding occurs, and bloody effusion appears in the abdominal cavity. Due to the progressive disruption of blood supply, necrosis of the intussusception occurs.

Pathogenesis

The pathogenesis of changes in obstruction does not depend on its type, but depends on a local stop in the movement of food through the intestines. This causes further changes that underlie the development of symptoms.

In the area of the pathological source in the intestine, the integrity and permeability of blood vessels and the peritoneum itself, which provide ultrafiltration of plasma and tissue fluid, is disrupted. This leads to plasma proteins containing inactive components of the blood coagulation system leaving the vascular bed and peritoneum into the abdominal cavity. These substances, upon contact with the damaged peritoneum and tissues of the abdominal organs, are activated, a cascade coagulation reaction occurs, which ends with the deposition of fibrin on the surface of the abdominal organs. This is facilitated by tissue coagulation factors contained in the tissue cells of the abdominal organs and peritoneal mesothelium. Fibrin, deposited on the surface of the abdominal organs, has adhesive properties and fixes adjacent organs. This leads to the fact that in the place where the food stopped, the layers of the intestine, as well as the mesentery, become even more sticky. This completely disrupts the movement of chyme and is the main mechanism of the pathogenesis of intestinal obstruction in a newborn.

Symptoms of intestinal obstruction in newborns

Symptoms of intestinal obstruction in newborns do not depend on the type, since the pathogenetic features of the pathology are not particularly different. The stages of development of disorders in intestinal obstruction proceed sequentially from circulatory disturbances in a certain area of the intestine to its necrosis. Considering that in newborns the intestinal wall is very thin, the period for the development of symptoms is reduced. When intestinal necrosis occurs, the whole process ends in peritonitis.

The first signs of acute intestinal obstruction begin suddenly and are characterized by a large polymorphism of clinical manifestations. The process quickly leads to severe intoxication, changes in homeostasis, causes various complications of the pathological process and worsens the patient’s condition.

The classic clinical picture of intestinal obstruction in a newborn is characterized by a sudden onset against a background of complete health. Pain in the intestines gradually arises, which is characterized by attacks of anxiety in newborns with the gradual addition of toxicosis.

Vomiting is one of the obligatory symptoms of this disease in newborns. With severe intestinal obstruction, vomiting appears on the first day of life after birth. Depending on the level of damage, the nature of vomiting may vary.

Thus, in conditions of complete obstruction, the vomit will have the appearance of curdled milk without bile impurities. If the process is localized slightly lower at the level of the distal parts of the small intestine, then the vomiting will be digested milk.

The nature of the newborn's stool also changes. With high obstruction, almost normal meconium will pass, normal in quantity and color. If the process of obstruction is slightly lower, then the meconium is practically not colored. There may also be bloody discharge from the rectum or streaks of blood in the baby's stool.

The general condition of newborns from the onset of the disease is satisfactory, but quickly

Exicosis and symptoms of malnutrition progress against the background of repeated vomiting and diarrhea. Dry skin, sunken eyes, fontanelle, and decreased tissue turgor appear. Later, swelling of the epigastrium is noted, which decreases after vomiting.

The clinical picture of paralytic intestinal obstruction is characterized by severe bloating, symptoms of intoxication, and retention of stool and gases. Since the paralytic focus is wider than with other types of obstruction, the bloating of the child’s tummy is very pronounced. This can disrupt the breathing process, which in turn is a prerequisite for the development of hypoxia and hypostatic pneumonia.

Body temperature does not rise often; intoxication phenomena are often accompanied by dehydration and electrolyte disturbances.

Congenital intestinal obstruction in a newborn has the same manifestations, but they appear immediately after the birth of the child. Vomiting, impaired passage of meconium, bloating - all these symptoms begin to appear within a few hours after birth.

Partial intestinal obstruction in a newborn is characterized by disorders in which the intestinal cavity is only half blocked. Therefore, the symptoms do not develop so acutely and they must be carefully differentiated from functional disorders in newborns.

Complications and consequences

The consequences and complications of intestinal obstruction can be very serious. Considering intestinal necrosis in the absence of timely treatment, one of the most common consequences is peritonitis. Longer-term consequences may develop if surgical treatment has been performed. In this case, dense adhesions often form, which can lead to repeated obstructions in the future. Persistent functional disorders of the intestines in children in the future are one of the common consequences of intestinal obstruction. If newborns with obstruction have other concomitant pathologies, the risk of mortality increases, including fatal complications.

Diagnosis of intestinal obstruction in newborns

Diagnosis of intestinal obstruction in newborns must necessarily be based on a thorough examination of the baby. After all, vomiting and stool disorders are nonspecific symptoms that are characteristic not only of intestinal obstruction.

It is imperative to examine the abdomen of a newborn child if any intestinal pathology is suspected.

When intussusception occurs against the background of intestinal manifestations, there are other local symptoms. A tumor-like formation with a doughy consistency is palpated, which can change its position when pressed. With paralytic obstruction, the abdomen looks sharply swollen and soft on palpation. Percussion reveals high tympanitis; auscultation reveals no peristaltic sounds. The normal process of motility is disrupted, so no noise is detected.

The tests that are necessary to diagnose obstruction are not specific, so at the initial stages they are limited to only general tests.

Instrumental diagnostics is the main and priority method for confirming the diagnosis of obstruction. X-ray examination allows you to determine the level of obstruction and degree, because gases and food accumulate above the level of the obstruction, and below there are no signs of normal motor skills. X-ray examination helps to verify the changes characteristic of high intestinal obstruction: pronounced accumulation of air in the upper intestines and determination of the level of fluid under these gases. The intestinal loops are arranged in such a way that they form “arcades”, which look like garlands, filled half with air and half with liquid. Normal intestine has a clear distribution and location of loops.

Differential diagnosis

Differential diagnosis should be carried out with congenital intestinal anomalies, esophageal atresia, pyloric stenosis. All these pathologies are symptomatically very similar, but a careful examination can determine the diagnosis.

Treatment of intestinal obstruction in newborns

If intestinal obstruction is suspected, treatment of the child in a hospital is mandatory. Therefore, if repeated vomiting or stool disturbance occurs, it is necessary to hospitalize the newborn if he was previously at home. If a newborn begins to have similar problems immediately after birth, it is imperative to consult a surgeon.

During the first 1.5-2 hours after the child’s hospitalization in the hospital, complex conservative therapy is carried out. Such treatment has differential diagnostic significance and, by its nature, can be preoperative preparation.

Therapy is aimed at preventing complications associated with painful shock, correcting homeostasis and at the same time represents an attempt to eliminate intestinal obstruction using non-surgical methods.

Measures aimed at combating abdominal pain shock include: neuroleptanalgesia (droperidol, fentanyl), perinephric novocaine blockade and administration of antispasmodics (baralgin, spasmoverine, spasfon, no-shpa). In children, the use of some drugs may be limited during the neonatal period, so treatment is carried out with the obligatory consultation of a pediatric anesthesiologist. Pain management is carried out after the diagnosis has been established.
Elimination of hypovolemia with correction of electrolyte, carbohydrate and protein metabolism is achieved by the introduction of salt blood substitutes, 5-10% solution of glucose, gelatin, albumin and blood plasma. All calculations are carried out taking into account the fluid needs of the newborn baby’s body, and in addition, they also take into account the needs for nutrients.
Correction of hemodynamic parameters, microcirculation and detoxification therapy is carried out using intravenous infusion of reopolyglucin, reogluman or neohemodez.
Decompression of the gastrointestinal tract is carried out using a nasogastric tube. A child with a confirmed diagnosis of intestinal obstruction should be transferred to total parenteral nutrition. Feeding of the child is prohibited and all substances are calculated based on body weight. At the time of treatment, enteral nutrition is completely prohibited; from the moment of recovery, breastfeeding is gradually introduced.
When treating paralytic obstruction, it is necessary to treat the underlying disease that caused the paresis. In addition, drug stimulation of intestinal motility is carried out with proserin and infusion solutions.

When there is obstruction, gradual necrosis necessarily occurs in this part of the intestine with the absorption of decay products and intoxication. This is always a prerequisite for the proliferation of bacteria, therefore, regardless of the treatment method, antibacterial therapy is used for intestinal obstruction. Only spastic and paralytic obstruction can be treated with conservative methods for several hours. All other types of obstruction should be treated by surgery without delay. In this case, initial antibacterial and infusion therapy is carried out for two to three hours, which is preoperative preparation.

Sulbactomax is a combination antibiotic that consists of the 3rd generation cephalosporin ceftriaxone and sulbactam. This composition makes the antibiotic more stable and is not destroyed by bacteria. This remedy is used for treatment in combination with other drugs. The method of administration is intravenous for faster action. The dosage of the drug is 100 milligrams per kilogram of body weight. Side effects can be in the form of allergic reactions, impaired renal function, and effects on the liver.
Kanamycin is an antibiotic from the macrolide group, which is used for newborns in the treatment of intestinal obstruction, both preoperative preparation and in the postoperative period to prevent complications. The dosage of the drug is 15 milligrams per kilogram of body weight per day for the first three days, then the dose can be reduced to 10 milligrams. Method of administration - intravenous or intramuscular, divided into 2 doses. Side effects can be in the form of irreversible hearing impairment, as well as toxic effects on the kidneys.

When the child’s condition is stabilized, mandatory surgical intervention is performed. Surgical treatment of intestinal obstruction is mandatory for obstructive and strangulation types. Since in these types there is a mechanical obstacle, it will not be possible to restore normal intestinal function with medication alone.

The problem can be eliminated with surgery, but sometimes conservative therapy is effective. The higher the blockage occurs, the more difficult the treatment. The prognosis depends on the timeliness of diagnosis.

Kinds

Intestinal obstruction in children can be congenital or acquired. In the first case, symptoms appear in the newborn a short time after birth. The course of the disease depends on the degree of blockage.

If intestinal obstruction in a baby is not diagnosed in time, this can lead to intestinal rupture and peritonitis.

The acquired form is most often diagnosed in infants aged 4 months to one year.

Classification depending on the mechanism of formation:

Dynamic. Occurs when intestinal motility is disrupted and mesenteric circulation slows down. It can be spastic (with prolonged intestinal tension) and paralytic (with relaxation of the intestine).
Mechanical. Occurs when there is a physical blockage, for example, by a foreign body, worms, or tumor.

According to the degree of obstruction:

Full. Poses a threat to the child's life. The baby cannot have a bowel movement and emergency surgery is required.
Partial. The intestinal lumen is not completely closed.

According to the level of intestinal involvement:

Low. The blockage occurs in the small intestine, ileum, or colon.
High. Occurs when the duodenum narrows.

According to the nature of the flow:

Spicy. This form is characterized by pronounced symptoms.
Chronic. This form develops with high obstruction. Symptoms increase slowly, pain is minor.

Causes

Causes of congenital intestinal obstruction in a child:

malformations of the intestine during the embryonic period;
pathologies of other gastrointestinal organs.

The blockage is formed at the stage of intrauterine development.

Causes of acquired intestinal obstruction in a child:

poor circulation in the intestine;
stagnation of feces in infants (meconium ileus);
formation of adhesions in the intestines;
blockage of the intestine by a tumor, foreign body, helminths, lump of food;
intestinal diverticula;
hernias in the abdominal cavity;
twisting or bending of the intestines;
intussusception (a condition in which the intestines fold in on themselves);
overeating due to prolonged fasting;
impaired peristalsis due to immaturity of the gastrointestinal tract;
complication after surgery on the abdominal organs;
long-term use of medications.

Symptoms

Symptoms of intestinal obstruction depend on the nature of the course and the degree of blockage. The acute form is characterized by the following symptoms:

the child feels severe pain in the abdomen, which can last from 2 to 12 hours;
after the painful sensations subside a little, signs of gastrointestinal dysfunction appear (bloating, flatulence, etc.);
after a day, the pain becomes unbearable, and the child’s condition worsens.

With chronic intestinal obstruction, cramping pain appears after eating. Babies are bothered by constipation and frequent vomiting.

In children under one year old

Infants are not able to describe their complaints, so parents need to carefully monitor the baby’s condition.

Symptoms of intestinal obstruction in infants:

There is acute pain and spasm in the abdomen. The child cries and clenches his legs. He cannot sit still, he tries to take a position that will reduce pain. After a while, the baby suddenly stops crying. The attacks may recur after 15-30 minutes.
Stool mixed with blood and mucus. Evacuation occurs after crying.
Lack of appetite.
Vomiting after an attack. Vomit may be mixed with bile.
Bloating and lack of stool (with complete blockage of the intestine). Partial blockage may result in diarrhea.

If treatment is not sought immediately, newborns may develop a fever.

In children after one year

The manifestations are:

attacks of cramping pain;
lack of appetite;
nausea and regular vomiting;
stool retention, problems with bowel movements.

With excessive vomiting, symptoms of dehydration occur.

Which doctor treats intestinal obstruction in children?

It is necessary to contact a pediatric gastroenterologist and surgeon.

Diagnostics

The diagnosis of “intestinal obstruction” in children is made on the basis of the following examination:

Examination of the child. The doctor palpates the abdomen. During palpation, swelling and pain are detected. A lump may be felt in the abdomen.
X-ray of the abdominal cavity.
Ultrasound. It is a more informative diagnostic method than x-rays.
Air or barium enema. Air or barium is introduced into. With intussusception, this technique is not only diagnostic, but also treatment.

Treatment

Intestinal obstruction in newborns is best treated in the surgical department.

Before the baby is given an accurate diagnosis, there is no need to do an enema, give a laxative or rinse the stomach.

Treatment is carried out only after a complete examination. It can be conservative or operative.

In the absence of complications, therapy consists of eliminating the symptoms of intoxication and removing intestinal blockage. The set of events looks like this:

To stop vomiting, a probe is inserted into the baby through the nasal cavity, with the help of which congestion in the upper digestive tract is removed.
With severe peristalsis, the baby is given antispasmodics.
Painkillers and antiemetics are prescribed.
To restore the water-salt balance, solutions are administered intravenously.
In case of intussusception, an air enema is given during the day. This procedure allows you to get rid of intestinal obstruction in newborns in 50-90% of cases.
A rectal tube can help treat volvulus.

In case of complete obstruction, surgery cannot be avoided. A bowel resection is performed (the affected area is removed).

Prevention

In most cases, it is impossible to prevent intestinal obstruction. The only preventative measure is proper nutrition. You need to include fermented milk products, fresh fruits and vegetables, prunes and high-fiber foods in your child’s diet.

The prognosis is favorable if help is provided to the baby in a timely manner. If not diagnosed in a timely manner, intestinal obstruction can cause infection and death of the baby.

Useful video about acute intestinal obstruction

Good afternoon How often congenital intestinal obstruction found in your
practice.

Intestinal obstruction in newborns is the most common cause and indication for emergency surgery in young patients.

Who should be the first to sound the alarm and diagnose intestinal obstruction in a newborn?

I'll tell you straight. The first suspicion of intestinal obstruction must be noticed by the doctor in the maternity ward. Neonatologist. The neonatologist should pay attention to the following points:

Assess medical history. In newborns with obstruction, obstetricians usually note polyhydramnios and an unfavorable course of pregnancy.
The general condition of the newborn is assessed. In case of obstruction, intoxication manifests itself, the level of hematocrit and hemoglobin is increased, acid-base balance disturbances and more.
Characteristic signs upon palpation of the child’s abdomen.
The stomach is probed to assess the quality and quantity of the contents.
Presence of meconium on rectal examination (absent in atresia).

If congenital intestinal obstruction is suspected, what should the maternity ward doctor do? Quickly deliver to your surgical department?

"Fast" is not the right word. Urgently. The child must be urgently transferred to a specialized surgical hospital, because the treatment of such a pathology is only surgical. You can't do it without a surgeon. The surgeon conducts differential diagnostics, determines the localization of congenital intestinal obstruction, etc.

Does the prognosis of the disease depend on the time of contacting a pediatric surgeon?

There is a direct correlation: less time for diagnosis means a favorable outcome. Again, it all depends on the attentiveness of the doctor in the maternity ward. With timely treatment, the prognosis in 99% of cases is favorable, if there is no other congenital pathology and an accurate diagnosis is made. Depending on the type and location of the obstruction, symptoms appear immediately or after a short period of time.

Why does congenital intestinal obstruction occur, what are the causes of this pathology? How to avoid obstruction, is it possible to protect yourself during pregnancy?

In this case, there are no special events, exercises, or diets for mothers. Follow the recommendations of your obstetricians. It is difficult, I would even say impossible, to influence the causes of obstruction. And that's why. Let's look at the causes of intestinal obstruction in newborns.

The first reason leading to obstruction is malformations of the intestinal tube during pregnancy. Defects occur during the development and formation of the intestinal tube. Common forms are stenosis and atresia. Localization is mainly in the duodenum, the initial parts of the jejunum and ileum. Rarely, multiple atresias occur. Types of atresia:

The second cause of intestinal obstruction in newborns is a violation of the process of intestinal rotation in the embryonic period. Types of obstruction:

midgut volvulus;
Ladd's syndrome - volvulus of the jejunum and compression of the duodenum;
partial duodenal obstruction and atypical location of the cecum.

The third reason is a malformation of the pancreas.

ring-shaped gland;
congenital cystofibrosis.

What symptoms are typical for newborns with intestinal obstruction? What should you be concerned about?

Symptoms depend on the location of the obstruction. They talk about high or low localization of the pathology, about complete or partial narrowing of the intestinal lumen.

Congenital intestinal obstruction still remains the main cause requiring emergency surgical intervention in the neonatal period. The clinical picture of intestinal obstruction in a newborn develops in the next few hours and days after birth, and in the absence of timely diagnosis and subsequent surgical intervention leads to the death of the child due to dehydration, intoxication, lack of nutrition and aspiration of gastric contents.

Epidemiology
On average, intestinal obstruction occurs in 1 in 1500-2000 live births.

Etiology
The causes of congenital intestinal obstruction may be the following:
- malformations of the intestinal tube (atresia, stenosis);
- developmental defects that cause compression of the intestinal lumen (ring-shaped pancreas, aberrant vessel, tumor);
- anomalies of intestinal rotation and fixation (midgut volvulus, Ladd syndrome);
- obstruction of the intestinal lumen with viscous meconium in cystic fibrosis (meconium ileus);
- disturbance of intestinal innervation (Hirschsprung's disease, neuronal dysplasia).

Based on the level of location of the obstacle, high and low intestinal obstruction are distinguished; each of them has a characteristic clinical picture.

High obstruction is caused by obstruction at the level of the duodenum and the initial parts of the jejunum, low - at the level of the distal parts of the jejunum, as well as the ileum and colon.

Duodenal obstruction
Epidemiology
The detection rate averages 1 case per 5,000–10,000 live births. In 30% of cases it is combined with Down syndrome.

Etiology
Considering the anatomical features of the duodenum, obstruction of this section can be caused by the following reasons: stenosis, atresia, compression of the lumen by abnormally located vessels (preduodenal portal vein, superior mesenteric artery), embryonic cords of the peritoneum (Ledd syndrome) and annular pancreas.

Prenatal diagnosis
Fetal ultrasound visualizes the dilated and fluid-filled stomach and duodenum in the upper abdominal cavity - a symptom of a double bladder, which, in combination with polyhydramnios, makes it possible to establish a diagnosis as early as 20 weeks of pregnancy.

If parents decide in favor of prolonging pregnancy, then in case of severe polyhydramnios, it is advisable to carry out therapeutic amniocentesis in order to prevent premature birth. Early diagnosis is extremely important: genetic counseling and fetal karyotype testing are required, since in 30% of cases this diagnosis is combined with Down syndrome.

Syndromology
When establishing a prenatal diagnosis of duodenal atresia, a comprehensive examination of the fetus is indicated, since in 40-62% of cases combined anomalies are possible. Among them, the most common are congenital defects of the heart and genitourinary system, defects of the gastrointestinal tract and hepatobiliary system. In addition, duodenal atresia can be part of a number of hereditary syndromes, among which should be Fanconi pancytopenia, hydantoin syndrome, Fryns, Opitz G, ODED syndromes (oculo-digito-esophageal-duodenal syndrome - syndrome of the eyes, limbs, esophagus, duodenum ), Townes-Brocks and TAR (thrombocytopenia with absent radius).

In addition, heterotaxy and the above-mentioned VACTER association have been described in duodenal atresia. Particular attention should be paid to prenatal karyotyping in duodenal atresia, since chromosomal abnormalities have a probability of 30-67%. Most often - Down syndrome. Familial cases with presumed autosomal recessive inheritance have been described.

Intrauterine diagnosis of duodenal atresia informs the neonatal team doctors in advance about the birth of such a child and allows them to organize emergency care for a sick newborn. If congenital intestinal obstruction is suspected, immediately after birth, a tube is inserted into the child’s stomach to decompress the gastrointestinal tract and prevent aspiration syndrome, enteral load is excluded, and the newborn is transferred under the supervision of a pediatric surgeon.

Clinical picture
Symptoms of high intestinal obstruction are detected already in the first hours after birth. The earliest and most persistent signs are repeated regurgitation and vomiting, and there may be a slight admixture of bile in the gastric contents. By installing a nasogastric tube immediately after birth, a large amount of contents (more than 40.0-50.0 ml) is evacuated from the stomach; subsequently, the liquid continues to flow passively through the tube. An inconsistent, but characteristic symptom is bloating in the epigastric region, in other parts the abdomen is sunken. Immediately after vomiting, bloating decreases. Palpation of the abdomen is painless. Obtaining meconium during a cleansing enema indicates partial intestinal obstruction or obstruction above the papilla of Vater, judging by the unimpeded flow of bile into the distal parts of the intestine. Together with gastric contents, the child loses a large amount of potassium and chlorides. Without treatment, dehydration quickly occurs. The child becomes lethargic, adynamic, physiological reflexes are reduced, the skin becomes pale and marbling, and microcirculation deteriorates.

Diagnostics
X-ray examination is used to confirm the diagnosis. For diagnostic purposes, direct radiography of the abdominal cavity is performed in a vertical position, on which two gas bubbles and two fluid levels are determined, corresponding to the distended stomach and duodenum. For most patients, this test is sufficient to make a diagnosis. In doubtful cases, the stomach is additionally filled with air or a water-soluble contrast agent, and the contrast accumulates above the obstruction zone.

Treatment
In case of high intestinal obstruction, the operation is performed on the 1st-4th day of the child’s life, depending on the severity of the condition at birth and concomitant diseases.

Forecast
Mortality is determined by the severity of combined malformations. In the long-term period, complications such as megaduodenum, duodeno-gastric and gastroesophageal reflux, peptic ulcers and cholelithiasis are noted in 12-15% of observations. Overall, the prognosis is favorable, with survival rates exceeding 90%.

Small bowel atresia
Congenital anomalies of the small intestine in most cases are represented by atresia.

Epidemiology
Occurs with a frequency of 1 in 1000-5000 live births. The distal ileum is more often affected - 40%, and the proximal and distal jejunum - in 30 and 20% of cases, respectively; obstruction of the proximal ileum is less common - 10%.

Prenatal diagnosis
Small intestinal obstruction in the fetus is visualized as multiple dilated intestinal loops, with the number of loops reflecting the level of obstruction. An increase in the amount of water and multiple dilated loops of the small intestine, especially with increased peristalsis and floating particles of meconium in the intestinal lumen, suggest small intestinal atresia.

Syndromology
There are combined malformations, mainly of the gastrointestinal tract (Hirschsprung's disease, additional areas of intestinal atresia, anomalies of the anorectal region) and urinary tract. Most cases of small intestinal atresia are sporadic. Unlike duodenal atresia, chromosomal aberrations are rare in small atresia. Prenatal karyotyping can be avoided because the frequency of chromosomal abnormalities in this defect is low. When pregnancy is prolonged and severe polyhydramnios is present, therapeutic amniocentesis is indicated to prevent premature birth.

Helping a newborn in the delivery room
Intrauterine signs of congenital obstruction of the small intestine in the fetus require organized action by the maternity hospital staff. A low level of obstruction causes a significant increase in the volume of the abdomen, which draws the doctor’s attention already at the initial examination. When inserting a gastric tube, a large amount of content is obtained, often stagnant in nature with an admixture of dark bile and small intestinal contents. The absence of meconium during a cleansing enema confirms the suspicion; an emergency transfer of the child to a pediatric surgical hospital is required.

Clinical picture
The child’s behavior in the first hours after birth does not differ from healthy behavior. The main sign of low intestinal obstruction is the absence of meconium. When performing a cleansing enema, only impressions of uncolored mucus are obtained. By the end of the first day of life, the child’s condition gradually worsens, anxiety and painful cry appear. Intoxication phenomena quickly increase - lethargy, adynamia, gray-earthy coloration of the skin, impaired microcirculation. Uniform bloating of the abdomen progresses, with intestinal loops contouring through the anterior abdominal wall. There is vomiting of stagnant intestinal contents. Upon examination, the abdomen is soft, accessible to palpation, painful due to overstretching of the intestinal loops. The course of the disease can be complicated by perforation of an intestinal loop and fecal peritonitis, in which case the child’s condition sharply worsens and signs of shock appear.

Diagnostics
Direct plain radiography of the abdominal cavity in an upright position demonstrates significant dilation of the intestinal loops, increased uneven gas filling and fluid levels in them. There is no gas filling of the underlying parts of the abdominal cavity. The more loops are visualized, the more distal the obstacle is located.

Treatment
A newborn with signs of low intestinal obstruction requires emergency surgical treatment. Preoperative preparation can take place within 6-24 hours, which allows for additional examination of the child and elimination of water and electrolyte disturbances. Preoperative preparation should not be prolonged due to the high risk of complications (intestinal perforation and peritonitis). The goal of surgery is to restore the integrity of the intestine while possibly maintaining its maximum length.

Forecast
The survival rate of patients with uncomplicated small bowel atresia is close to 100%. Mortality is caused by complications and unfavorable background such as prematurity, intrauterine growth retardation, intestinal perforation or volvulus, and cystic fibrosis of the pancreas.

Atresia and stenosis of the colon
Epidemiology
This is the rarest type of intestinal atresia: it occurs in no more than 1 in 20,000 live births. Lesions of the transverse colon and sigmoid colon are most often observed. Colon atresia occurs in less than 5% of all intestinal atresia cases.

Prenatal diagnosis
Obstruction of the colon in the fetus can be suspected if dilated loops of the colon filled with hypoechoic contents with inclusions are detected. However, in most cases, this pathology is not diagnosed prenatally due to the resorption of fluid from the intestine and uniform expansion of the intestine throughout - without areas of significant increase in diameter. When dilated loops of the colon are detected, the differential diagnosis should be made with Hirschsprung's disease, anorectal pathology, megacystis-microcolon-intestinal hypoperistaltic syndrome and meconium peritonitis.

Intestinal obstruction (volvulus) occurs in people at any age, but for children this disease is especially dangerous. The child’s body is not yet developed enough, so problems with the gastrointestinal tract can cause serious complications. Intestinal obstruction in children causes pain in the tummy, nausea and profuse vomiting.

Intestinal obstruction (intussusception) in children is a serious condition in which part of the intestine penetrates (slips, wraps up) into the adjacent part of the intestine, as a result of which the movement of feces through the intestine completely or partially stops. For this reason, the disease is sometimes called “volvulus.” Volvulus in children often blocks the movement of stool and also cuts off blood flow to part of the intestine, which can lead to a tear in the intestine (perforation), infection, and death of intestinal tissue. In severe cases, surgery is required to eliminate the disease.

The complexity of the development and course of the disease depends on in which part of the intestine the obstruction occurs. The disease is most acute if the blockage occurs in the upper part of the intestine.

The disease develops rapidly: the first signs appear within a short period of time and develop very quickly.

Types of disease

Blockage of certain parts of the intestine can occur in children of any age, including infants and newborns.

Main types of intestinal obstruction:

Congenital. This type of disease occurs due to pathologies during the development of the child’s gastrointestinal system. In some cases, at an early stage of intrauterine development, congenital intestinal obstruction develops in the fetus even before birth. As a result, the baby is born with this disease. The course of the disease depends on the degree and level of obstruction. When the level of blockage is high, the newborn vomits bile. A low degree of obstruction is characterized by the presence of stool retention and gag reflexes in the child, which occur a few days after birth.
Acquired. There are various forms of acquired disease. The most common type of disease is mechanical obstruction (intussusception). Less commonly, intestinal obstruction occurs due to the presence of adhesions. The disease is observed in small children from birth to 1 year. This type of intestinal blockage occurs suddenly and is characterized by acute pain and vomiting. Your baby's stool may contain blood and mucus.

Causes of the disease

In the vast majority of cases, the cause of intussusception in children is unknown. Since intussusception occurs more often in the autumn-winter period and in many children intussusception occurs during acute respiratory viral infections, a number of scientists associate intestinal obstruction with the effects of viruses that cause these acute respiratory viral infections.

Risk factors for intussusception include:

Age. Children—especially young children—are much more likely to develop intussusception than adults. Intestinal obstruction is most often diagnosed in children aged 6 months to 3 years.
Floor. Invasion most often affects boys.
Abnormal formation of the intestinal tract. Intestinal malrotation is a condition in which the intestines do not develop or fold correctly, and this increases the risk of intussusception.
History of intussusception. If a child has already had intussusception once, he or she is at increased risk of developing the condition again. Invasion recurs in more than 10% of patients.
Family history. If there is a history of intussusception in the family, the child has an increased risk of this disease.

Signs and diagnosis of the disease in children

How to determine that a child has a volvulus? There are several signs. The most important one is:

Cramping pain. The first sign of an intestinal obstruction in a baby may be sudden, loud crying caused by abdominal pain. Babies under one year old with abdominal pain may pull their knees toward their chest when they cry. The pain comes and goes, usually every 15 to 20 minutes. Over time, these painful episodes last longer and occur more frequently;

Other common signs and symptoms of intestinal obstruction include:

Lack of appetite, refusal to eat;
Bloating (flatulence);
Nausea and vomiting;
Retention of stool;
Lump in the abdominal cavity;
Difficulty or absent stool;
In some cases, diarrhea is possible;
Temperature increase;
The presence of bloody discharge and mucus in the stool, visually similar to “currant jelly”;
Lethargy.

Not all children have all of these symptoms. Some children do not have blood in their stool or a lump in their abdomen. Some older children have no symptoms other than pain.

Invasion requires emergency medical care. If your child develops the signs or symptoms listed above, get medical help right away.

Remember that in young children (up to one year old), signs of abdominal pain may include periodic drawing of the knees to the chest and crying.

Important! If a child experiences severe abdominal pain, it is necessary to urgently seek medical help. Intestinal obstruction in the vast majority of cases is accompanied by abdominal pain of varying intensity.

If a child experiences the above symptoms, parents should immediately contact a surgeon or pediatrician. The doctor will conduct diagnostics, make a diagnosis and prescribe treatment that will correspond to the child’s age and the severity of the disease.

These symptoms are similar to other diseases such as appendicitis.

Possible complications

An intestinal obstruction can cut off blood flow to the affected part of the intestine. If this condition is left untreated, the lack of blood causes tissue in the intestinal wall to die, and it can also lead to a tear (perforation) in the intestinal wall, which can cause an infection in the abdomen (peritonitis).

Diagnosis of the disease

Be prepared to provide full information to your doctor on the following questions:

When did your child start experiencing stomach pain or other symptoms?
Is the pain continuous or intermittent?
Does the pain start and end suddenly?
Has your child experienced nausea, vomiting, or?
Have you noticed your child?
Have you noticed any swelling or swelling in your baby's abdomen?

To confirm the diagnosis, the doctor may prescribe:

Ultrasound or other diagnostic imaging procedure of the abdominal organs. An ultrasound, X-ray, or computed tomography (CT) scan may reveal an intestinal obstruction. The results of the obtained images, as a rule, show a “bull’s-eye”, which is the intestine rolled up in intussusception. Abdominal imaging can also show if the intestine has been ruptured (perforated).
Air or barium enema. An air or barium enema enhances visualization of the colon. During the procedure, the doctor will insert air or liquid barium into the colon through the rectum. In addition, an air or barium enema can in many cases correct the intussusception itself, in which case no additional treatment is required. A barium enema cannot be used if there is an intestinal rupture (perforation).

Treatment of illness in a baby

If you notice signs of intestinal obstruction in a child, do not give him food or medicine until he has been examined by a doctor.

Important! If a child develops symptoms of intestinal obstruction, urgent hospitalization is necessary. Self-medication can lead to complications and serious consequences.

Emergency medical attention is required to avoid dehydration and severe shock, and to prevent infection that can occur when part of the intestine dies due to lack of blood.

The baby is examined for the presence of intestinal disease by a surgeon. If complications occur, surgical intervention is necessary.

To treat intestinal obstruction, your doctor may prescribe:

Air enema or barium enema. It is both a diagnostic procedure and a treatment. If the enema works, further treatment is usually not required. This procedure is very effective in children.
Surgery. If the intestines rupture or enemas fail to straighten the intestines, surgery is necessary. The surgeon will release the part of the intestine that has become twisted, remove the blockage (obstruction), and, if necessary, remove dead intestinal tissue.

If the intestinal disease is not in an acute, advanced stage, conservative therapy is prescribed. It consists of a set of procedures to remove stagnant feces from the intestines and cleanse the body of harmful substances and toxins.

The following procedures may also be prescribed to your baby:

To stop the vomiting process, the stomach is lavaged through a special tube;
Medicines are administered intravenously that help restore water-salt balance;
Antiemetic, analgesic and antispasmodic medications;
If treatment is successful, the baby may be prescribed the medicine proserin, which stimulates proper intestinal activity.

Prevention of recurrence of the disease

After eliminating the causes and symptoms of intestinal obstruction, the child should follow a diet for some time. The child's diet should contain only those foods that have a positive effect on the intestinal microflora.

The diet is aimed at eliminating putrefactive processes and fermentation in the gastrointestinal tract.

Basic rules for feeding a baby after an illness.

Food products that contribute to the formation of gases should be excluded;
The daily menu should consist of low-fat broths, steamed meat, pureed dishes;
The child should not be given sweets, starchy foods, as well as salty and fried foods;
The baby should be given rosehip decoction and green tea at least twice a day;
In summer, it is recommended to include fruit jelly, compotes and fruit drinks in a child’s diet;
The child should consume fermented milk products daily.

If the diet is not followed, every second child ends up in the hospital again with a relapse of the disease.

Intestinal obstruction in young children can occur in different forms. It is very important to consult a specialist in time and begin treatment to avoid complications.

Be healthy!