Intestinal obstruction in Children

Intestinal obstruction in Children

1. INTESTINAL OBSTRUCTION

2. INTESTINAL OBSTRUCTION
History:
Age: e g :
•Neonate: Meconium ileus.
Hirschprung’s disease.
Malrotation.
Intestinal atresia.
•2 -24 months : Intususception (>24 M)
Hirschprung’s disease.
•Children : Hernia

4. Clinical features :
•Pain.
•Vomiting.
•Distention.
•Constipation.

5. Features vary according to :
•Site of obstruction .
•Age of Presentation.
•Underlying pathology.
•The presence or absence of intestinal
ischemia.

6. Other manifestations:
•Dehydration.
•Hypokalemia.
•Pyrexia.
•Abdominal distention.

7. Definitions:
•Ileus : Mechanical or functional intes.
Obstruction (Adynamic or paralytic).
•Mechanical obstruction :complete or partial
blockage of the intes. Lumen.
•Simple obstruction: one obstructing point.
•Closed loop obstruction :both the afferent and
the efferent loops are obstructed.
•Strangulation : where the blood supply to the
affected part of the intestine is impaired more
likely to sustained increased intraluminal
pressur.

9. Intestinal
obstruction
Dynamic Adynamic
Extrensic
Absent peristalsis
eg. paralytic ileus
Present peristalsis
eg.
mesenteric v. occ.
Pseudoobstruction
Intraluminal
obst.
Mural

11. Mechanical Intestinal obstruction
Small intestine Large intestine
Exterensic:
•Adhesions
•Hernias
Adhesions
Hernias
•Congenital:
Malrotation with
ladds band
Volvulous:
sigmoid 60-80%
coecal 20-40%

12. Malrotation

13. Malrotation

14. Malrotation

15. Mechanical intestinal obstruction
•Annular pancreas
(duodenal obstruction).

16. Annular pancreas

17. Duodenal obstruction

18. Mechanical intestinal obstruction
Sup. mesenteric
a. syndrome
(compression of
3
rd
part of
duodenum ).

19. Ischemic bowel

20. Mechanical intestinal obstruction
Mural:
•Small
bowel
atresia.
•Imperforated
anus.

21. Multiple atresia

22. Mechanical intestinal obstruction
•Stenosis.
•Webs
(diaphragm).

23. Duodenal web

24. Duodenal web

25. Duodenal web

26. Mechanical intestinal obstruction
Inflamatory :
•Regional
enteritis.
(Crohn’s desease.)
•Radiational
enteritis, stricture.
Neoplastic :
Small bowel
neoplasms.
•Ulcerative collitis.
•Diverticulitis.
•Radiational enteritis.

27. Mechanical intestinal obstruction
Intra luminal
obstruction:
•F.B. (Barium ,
worms)
•Gallstone ileus
(more common
in elderly).
•F.B. (Constipation
, Barium , worms)

28. F.B in the G.I.T

29. F.B in the G.I.T

30. Mechanical intestinal obstruction
•Meconium
ileus.
•Meconium
ileus.

31. Intussusception Intussusception

32. Intussusception

33. Medical causes of small & Large
bowel obstruction
Medications
Response to
localized
Inflammatory
process
Diffuse
peritonitis
Retroperitoneal
process
Neuropathic
disorders
Post. Operative
ileus
Metabolic
cases

34. Medical causes of small & Large
bowel obstruction
Metabolic:
1.Hypokalemia.
2.Hypomagnesemia.
3.Hyponatremia.
4.Ketoacidosis.
5.Uremia.
6.Porphyria.
7.Heavy metal poisoning.

35. Medications:
1.Narcotics.
2.Antipsychotics.
3.Anticholinergics.
4.Ganglionic blockers.
5.Agents used to treat Parkinson’s
disease.

36. For optimal treatment to be instituted,
five questions must be answered:
•Is the diagnosis intestinal obstruction?. Is
the obstruction is mechanical? .
•What is the level of obstruction?.
•Is there evidence of bowel wall ischemia or
perforation?.
•How sever is the associated systemic
disorders?.

37. Retroperitoneal process:
1.Retroperitoneal hematoma.
2.Pancreatitis.
3.Spinal or pelvic fracture.

38. Neuropathic disorders:
1.Diabetes.
2.Multiple sclerosis.
3.Scleroderma.
4.Lupus erythrematosis.
5.Hirschsprung’s disease.

39. Post. Operative ileus following
intra-abdominal surgery:
AS the motility usually returns for
the:
small bowel within 24 –48 hrs.
gastric within 48 hrs.
colonic within 3-5 days.

40. SHOKRAN