Neonatal Bowel Obstruction

Differential diagnosis

  • Proximal bowel obstruction
    • Malrotation and volvulus
    • Duodenal atresia
    • Jejunoileal atresia
    • Esophageal atresia
    • Tracheoesophageal fistula
    • Hypertrophic pyloric stenosis
  • Distal bowel obstruction
    • Meconium ileus
    • Meconium plug syndrome
    • Hirschsprung’s disease
    • Colonic atresia
    • Imperforate anus

* Midgut volvulus from malrotation is a life-threatening surgical emergency in the newborn.

Presentation

  • Proximal bowel obstruction
    • Vomiting (if the obstruction is distal to the drainage of the common bile duct at the ampulla of Vater in the second portion of the duodenum, the vomitus is likely to be bilious)
    • Abdominal distention
    • X-rays: little gas beyond the proximal duodenum
    • Upper GI contrast study
    • Placement of a nasogastric tube may be both diagnostic and therapeutic
  • Distal bowel obstruction
    • Distention
    • X-rays: proximal air-filled dilated small-bowel loops but no distal air
    • Contrast enema

History

  • Vomiting
    • Projectile?
    • Bilious?
    • Blood?
  • Abdominal Pain
  • Obstipation
  • Alternating diarrhea and constipation
  • Hematochezia (volvulus, intussusception)

Physical exam

  • Vitals
  • Abdomen: distention, visible mass, visible peristalsis, bowel sounds, palpation (tenderness, mass, peritoneal signs), rectal exam
  • Dehydration, FTT, malnutrition

Investigations

  • CBCD, lytes, BUN, Cr
  • Urinalysis
  • 3views of abdomen
    • Duodenal atresia: double bubble sign
    • Meconium peritonitis: calcifications within peritoneum = perforation
    • Meconium ileus: hazy, ground-glass pattern; string of beads sign
    • Hirschsprung’s: transition zone
  • +/- barium study

Management

  • NG decompression
  • IV fluids
  • Surgical correction

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