INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

By: Brig Mushahid AslamBy: Brig Mushahid Aslam

“Neither sun shall rise nor set on patient of intestinal obstruction”

SequenceSequence

Duodenal AtresiaDuodenal Atresia

Jejuno-ileal AtresiaJejuno-ileal Atresia

Meconium IleusMeconium Ileus

Definitions AgenesisAgenesis absence of organ or primordiumabsence of organ or primordium AplasiaAplasia absence of organ due to failure absence of organ due to failure

of of primordiumprimordium AtresiaAtresia absence of an openingabsence of an opening HypoplasiaHypoplasia incomplete development of an incomplete development of an

organorgan HyperplasiaHyperplasia overdevelopment of an organoverdevelopment of an organ DysplasiaDysplasia abnormal cell organizationabnormal cell organization

Duodenal AtresiaDuodenal Atresia

1: 50001: 5000 Associated AnomaliesAssociated Anomalies

Down’s Syndrome 30 % Congenital Heart Diseases Malrotation Anorectal Malformations

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

PresentationPresentation

AntenatalAntenatal USG

Polyhydramnios Distended stomach and 1st part Duodenum

NewbornNewborn Feeding Intolerance Bilious Vomiting Scaphoid Abdomen Failure to pass Meconium

AssociationAssociation

TypesType I：Complete membrane obstructing the lumen

Type II：A pouch with a fibrous cord connecting to the distal duodenum

Type III：blind-ending pouch with no connection to the distal duodenum

InvestigationsInvestigations

ManagementManagement

NPONPO Nasogastric aspirationNasogastric aspiration Intravenous fluidsIntravenous fluids AntibioticsAntibiotics SurgerySurgery

5’ Hs5’ Hs

HypothermiaHypothermia HypoxiaHypoxia HypovolemiaHypovolemia HypoglycaemiaHypoglycaemia HypoprothrombinaemiaHypoprothrombinaemia

ManagementManagement

ManagementManagement

Jejuno-ileal Atresia Jejuno-ileal Atresia

1/2000 1/2000 Vomiting Vomiting

Abdominal DistensionAbdominal Distension

Failure to pass meconiumFailure 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

Types Types

“APPLE PEEL” ATRESIA

CONGENITAL MIDGUT ATRESIA

TypesTypes

InvestigationsInvestigations

ManagementManagement

ManagementManagement

Meconium IeusMeconium Ieus

30 % intestinal obstruction30 % intestinal obstruction Associated AnomaliesAssociated Anomalies

Cystic Fibrosis 15% Atresia Malrotation

PresentationPresentation

NewbornNewborn Feeding Intolerance Bilious Vomiting Abdominal Distention Failure to pass Meconium

InvestigationsInvestigations

TreatmentTreatment

Hypertonic Enema WashoutsHypertonic Enema Washouts Gastrograffin 25-50 %

Effective 30-60 % cases

N-Acetyl cysteine 10 %

ManagementManagement