Intestinal Obstruction In Pediatric Patients 5q2w56

Intestinal Obstruction in Pediatric Patients Dr. Sugianto Prajitno, Sp.BA

Introduction Pediatric intestinal obstruction often result in life threatening and mandates immediate surgical intervention The diagnostic of intestinal obstruction in pediatric patients is challenging Delay in diagnosis might cause physiological alterations and usually fatal

Pathophysiology Venous obstruction

Dilatation proximal to obstruction

Accumulating secretions

Edema of bowel segment Arterial blockage Ischaemic necrosis

Blockage of intestine

Bacterial translocation

Perforation

Septicaemia

Peritonitis

Intestinal Obstruction Classification Onset: Acute intestinal obstruction Chronic partial intestinal obstruction

Age: Newborn Infant to 24 months 24 months or older

Intestinal obstruction

Level of obstruction: Duodenal Jejunal Ileal/colonic Anus

Congenital Acquired

Acute Intestinal Obstruction Sign & symptoms

Bilious emesis

 

Abdominal distention

No ing gas

Colicky Pain

Pediatric bilious emesis is a surgical emergency until proven otherwise A child with intestinal obstruction can still have bowel movements, but they won’t gas

Acute Intestinal Obstruction Plain Abdominal X-Ray High intestinal obstruction

Low intestinal obstruction

Non-specific

Double bubble (Duodenal Atresia)

Many gas filled loops of intestinal (Ileal atresia, meconium ileus, meconium plug syndrome, Hirschsprung disease)

May show bowel obstruction, double bubble or gasless (Malrotation)

Few gas filled loops beyond duodenum (Jejunal Atresia)

Acute Intestinal Obstruction Upper G.I. Series Bird’s beak  Malrotation Doule buble, distal air  Stenosis duodenum String sign  Pyloric stenosis

Acute Intestinal Obstruction Contrast Enema Contrast enema differentiate the various types of low intestinal obstruction Microcolon  jejuno-ileal atresia Soap bubble appearance  Meconium ileus Transitional zone  Hirschsprungs disease

Cupping, coiled spring  intussusception High position of caecum  malrotation

Acute Intestinal Obstruction Ultrasonography and Doppler USG Target sign  Intussusception Inversion of the superior mesenteric vessel orientation  Malrotation Whirlpool sign  Midgut volvulus

Diagnosis 

Diagnosis of pediatric intestinal obstruction is made base on:

Clear history taking

Accurate physical examination

Laboratory and imaging evaluation

Duodenal Atresia Scaphoid abdomen

Double bubble appearance

Jejuno-ileal Atresia Microcolon

Bowel contour

Jejunal atresia

Hirschsprung’s disease

Hirschsprung’s disease

Transitional zone in colon

Transitional zone

Malrotation and Midgut Volvulus

Malrotation and Midgut Volvulus

Malrotation and Midgut Volvulus

Malrotation and Midgut Volvulus Contrast enema

Upper GI series

Malrotation and Midgut Volvulus Inversion of the superior mesenteric vessel orientation is shown by Ultrasonography

Doppler USG The “Whirlpool” Sign

Meconium Ileus

Intestinal Adhesion

Intussusception

Sausage like mass

Intussuseption

Currant jelly stool

Intussusception Target’s sign

Intussusception

Cupping

Conclusion 

Every pediatric patients with intestinal obstruction should be considered as a surgical emergency until proven otherwise



Management of pediatric intestinal obstruction: The earlier the diagnosis, the better the result

Thank You