Intestinal obstruction in children is a pathology in which there is a partial or complete blockage of the small or large intestine. It interferes with the passage of food, liquids, and gas through the intestines normally. The blockage can cause severe pain that comes and goes. Bowel obstruction in newborns occurs in about 1 in 1,500 cases. Bowel obstruction should be suspected in any child with persistent abdominal pain, persistent vomiting, and bloating, as delayed diagnosis and treatment can be devastating.
Undiagnosed or improperly controlled obstruction leads to damage to the intestinal vascular system. This reduces its blood supply, then tissue death, destruction of the intestinal walls, infection of the whole organism occurs. This is fatal.
Varieties of intestinal obstruction in a newborn: criteria for classification
Many different pathological processes can cause intestinal obstruction in children.
Divide congenital and acquired obstruction. Congenital intestinal obstruction is caused by a violation of the intrauterine development of the child.
Its reasons may be:
- embryonic intestinal malformations;
- violation of the intestinal rotation process during the formation of the gastrointestinal tract;
- pathology of the development of other organs of the abdominal cavity.
Acquired intestinal obstruction in children is the result of inflammatory processes or surgery.
There are several classifications of intestinal obstruction according to various criteria:
1) The presence or absence of a physical obstacle
Intestinal obstruction are divided into: mechanical and dynamic.
- mechanical obstruction Is a physical blockage of the intestine by a tumor, scar tissue, or other type of block that prevents intestinal contents from passing through the point of blockage;
- dynamic obstruction occurs when the healthy undulating contractions of the muscles of the intestinal walls (peristalsis), which move the products of digestion through the gastrointestinal tract, are disrupted or stopped altogether.
2) The level of the affected area of the intestine
it high and low intestinal obstruction:
- high intestinal obstruction in newborns is observed with atresia (overgrowth) or stenosis (narrowing) of the duodenum;
- low intestinal obstruction may result from atresia or stenosis of the small intestine, ileum, and ascending colon.
3) The degree of obstruction:
- complete intestinal obstruction. With her, there is an absolute absence of stool;
- with partial obstruction, a small amount of stool passes.
4) The rate of development of symptoms:
- acute intestinal obstruction in children is characterized by rapidly developing symptoms;
- chronic. It is characterized by slowly developing symptoms, pain may not appear. It is more common with high intestinal obstruction.
Symptoms of intestinal obstruction in acute form, in contrast to chronic, slowly progress, but tend to suddenly intensify or accelerate.
5) Number of points of obstruction:
- simple obstruction. This is when there is a violation of the movement of intestinal contents due to the presence of a physical obstacle closing the lumen, but the contents of the lumen can move back;
- closed loop. This occurs when the intestinal lumen is blocked at two points where the contents of the intestine cannot move forward or backward;
- restrained obstruction. It occurs when there is a violation of the blood supply to the occluded segment.
Obstruction reasons
The causes of obstruction of the small intestine in children are most often the following may be:
- intussusception, volvulus, adhesions;
- hernia.
The most common causes of large intestinal obstruction are:
- volvulus;
- tumors;
- diverticula. These are small sacs that form in the intestinal wall that can fill up with food and expand, blocking the intestines.
Mechanical obstruction in children under one year old can occur due to intussusception, volvulus and hernia.
Meconium obstruction
Meconium ileus in newborns is a disorder in which meconium (original feces) is abnormally dense and fibrous, rather than a collection of mucus and bile that usually comes out easily. Abnormal meconium is blocking the intestines and must be removed with an enema or surgery.
This is due to a deficiency in trypsin and other digestive enzymes produced in the pancreas. It is also one of the earliest signs of developing cystic fibrosis in an infant. Intussusception usually follows an infection that causes an enlargement of the lymph node in the intestine, which acts as a folding point for intussusception.
Hirschsprung's disease
Hirschsprung's disease (congenital megacolon), possibly associated with meconium obstruction, is a motor disorder that occurs in 25 percent of newborns with dynamic intestinal obstruction, although symptoms may only develop in late infancy or childhood, delaying diagnosis.
Children with Hirschsprung's disease lack nerve cells (ganglia) in the walls of the large intestine. This seriously affects the undulating motion that propels the digested food forward. In most cases, in children with this disease, the first sign is the absence of stool with meconium in the first two days after birth.
From birth to 2 years of age, these babies will develop other signs such as chronic constipation, occasional watery stools in small quantities, a distended abdomen, poor appetite, vomiting, poor weight gain, and developmental delay. Most children will need surgery to remove the affected part of the large intestine.
Surgical intervention can be performed at the age of six months, or immediately after the correct diagnosis is made in an older child.
Symptoms can be resolved in at least 90 percent of cases born with Hirschsprung's disease. The disease is sometimes associated with other congenital conditions such as Down's syndrome.
Volvulus
Volvulus is the self-twisting of the small or large intestine (malrotation). Colon volvulus rarely occurs in young children. It usually occurs in the sigmoid colon - the lower part of the large intestine.
Duodenal valve
The duodenal seal occurs when the duodenum is twisted, the section of the intestine that connects the stomach and small intestine. Twisting any part of the intestine interrupts the flow of blood into the intestinal loop (strangulation), reducing the flow of oxygen to the tissues (ischemia) and leading to death of the intestinal tissue (gangrene).
Strangulation occurs in about 25% of bowel obstruction cases and is a serious condition that progresses to gangrene within half a day.
Intussusception
Intussusception is a condition where the intestine folds into itself, like a radio antenna. Intussusception is the most common cause of intestinal obstruction in children from three months to six years of age.
Adhesions and hernias
Hernias can also block part of the intestines and block the passage of food.
Congenital or post-surgical adhesions also lead to intestinal obstruction in children. Adhesions are strips of fibrous tissue that attach to each other, or to abdominal organs and intestinal loops. Thus, the space between the walls of the intestine is narrowed, and by pinching parts of the intestine, the passage of food is blocked.
In adults, adhesions are most often caused by surgery. Children who have had abdominal surgery may also develop adhesive ileus. It is not known exactly what causes the abnormal growth of fibrous tissue in congenital adhesions.
Symptoms of intestinal obstruction in children
The symptoms of bowel obstruction are variable.
Some of them are more common or appear earlier than others. It depends on the location and type of blockage.
- Vomiting usually occurs early, followed by constipation. This is the case when the small intestine is involved.
- Early onset of constipation followed by vomiting is more common with a blockage in the colon.
- Symptoms of a blockage in the small intestine tend to progress more quickly, while symptoms of a blockage in the colon are usually milder and develop gradually.
It is difficult to diagnose any type of bowel obstruction in infants, as young children are unable to describe their complaints.
Parents need to watch their child for changes and signs that indicate obstruction.
- The first signs of mechanical intestinal obstruction are abdominal pain or crampsthat come and go in waves. The kid, as a rule, squeezes his legs and cries in pain, and then suddenly stops. He may be calm for a quarter or half an hour between crying attacks. Then he starts crying again when another attack comes. Spasms are caused by the inability of the intestinal muscles to push the digested food through the blockage.
- The classic symptom of intussusception is bloody stool in infants after a crying attack.
- Vomiting - Another typical symptom of intestinal obstruction. The timing of its appearance is the key to the obstacle level. Vomiting follows soon after pain if the blockage is in the small intestine, but is delayed if it is in the large intestine. Vomit may be green from bile or have a fecal appearance.
- When fully locked the baby's intestines will not pass gas or feces... However, if the obstruction is only partial, diarrhea may occur.
- At the onset of the disease no fever.
Complications of obstruction
When the contents in the intestine do not pass the obstacle, the body absorbs a lot of fluid from the intestinal lumen. The abdominal area becomes painful to the touch, the skin on it looks stretched and shiny. Constant vomiting leads the body to dehydration.
An imbalance in fluid disrupts the balance of certain significant chemical elements (electrolytes) in the blood, which can cause complications such as irregular heartbeat and, if electrolyte balance is not restored, shock.
Renal failure is a dangerous complication resulting from severe dehydration (dehydration) and / or systemic infection due to intestinal disruption.
Diagnostics
Tests and procedures that are used to diagnose intestinal obstruction:
- physical examination... The doctor will ask about the medical history and symptoms. To assess the situation, he will also conduct a physical examination of the child. The doctor may suspect a bowel obstruction if the baby's belly is swollen or tender, or if a lump is felt in the belly. The doctor will also listen to sounds in the intestines with a stethoscope;
- radiography... Your doctor may recommend an abdominal x-ray to confirm the diagnosis of an intestinal obstruction. However, some obstructions in the intestines cannot be seen with standard X-rays;
- CT scan (CT). A CT scan combines a series of X-ray images taken from different angles to produce cross-sectional images. These images are more detailed than standard X-rays and are more likely to show bowel obstruction;
- ultrasound procedure... When bowel obstruction occurs in children, ultrasound is often the preferred examination;
- air or barium enema... During the procedure, the doctor will inject liquid barium or air into the large intestine through the rectum. For intussusception in children, an air enema or barium enema can actually fix the problem and no further treatment is needed.
Treatment of intestinal obstruction in children
Children with suspected intestinal obstruction will be hospitalized after an initial diagnostic examination. They will begin to treat immediately in order to avoid pinching the intestinal loops, which can be fatal.
- The first step in treatment is the insertion of a nasogastric tube to remove the contents of the stomach and intestines.
- Intravenous fluids will be given to prevent dehydration and correct electrolyte ion imbalances that may have already occurred.
- In some cases, it is possible to avoid surgery. Volvulus, for example, can be managed with a rectal tube inserted into the intestines.
- In infants, a barium enema can treat intussusception in 50 to 90% of cases.
- A different, newer contrast agent, a gastrograph, can be used. It is believed to have therapeutic properties as well as the ability to improve bowel scans.
- Sometimes an air enema is used instead of a barium enema or a gastrograph. This manipulation has successfully treated a partial obstruction in many infants.
Children usually stay in the hospital for observation two to three days after these procedures.
Operative intervention
Surgical treatment is necessary if other efforts cannot correct or eliminate the blockage.
As a rule, complete obstruction requires surgery, while partial obstruction does not. Restrained areas of the intestine require urgent surgery. The affected area is removed and part of the intestine is excised (bowel resection).
If the obstruction is caused by a tumor, polyps, or scar tissue, they will be surgically removed. Hernias, if present, are repaired to correct the obstruction.
Antibiotics can be given before or after surgery to avoid the threat of infection at the blockage site. Fluid replenishment is made intravenously as needed.
Immediate (urgent) surgery is often the only way to correct intestinal obstruction. As an alternative treatment, a high fiber diet can be recommended to stimulate proper stool formation.
However, common constipation is not the cause of intestinal obstruction.
Forecast
Most types of intestinal obstruction can be corrected with early treatment and the affected child will recover without complications.
Uncontrolled intestinal obstruction can be fatal.
The intestine is either pinched or loses its integrity (perforated), causing massive infection of the body. The recurrence rate is as high as 80% in those for whom volvulus is treated with medication rather than surgery.
Relapses in infants with intussusception usually occur within the first 36 hours after the blockage has cleared. The mortality rate in unsuccessfully treated children is 1 - 2%.
Prevention
Most cases of bowel obstruction cannot be prevented. Surgical removal of tumors or polyps in the intestine can help prevent relapse, although adhesions can form after surgery, further causing obstruction.
Preventing some types of intestinal problems that lead to bowel obstruction is by ensuring a diet that contains enough fiber to promote normal bowel movements and regular bowel movements.
Preventive nutrition includes:
- Foods high in coarse fiber (whole grain breads and cereals)
- apples and other fresh fruits;
- dried fruits, prunes;
- fresh raw vegetables;
- beans and lentils;
- nuts and seeds.
Diagnosis of intestinal obstruction in a child depends on recognizing related symptoms.
It's important to remember that a healthy diet with plenty of fruits, vegetables, grains, and plenty of water throughout the day will help keep your gut healthy.
Parents should be aware of their child's bowel habits and report cases of constipation, diarrhea, abdominal pain and vomiting to the pediatrician when this occurs.
There are many potential causes of intestinal obstruction. Often this ailment cannot be prevented. Timely diagnosis and treatment are essential. Uncontrolled bowel obstruction can be fatal.
