INTESTINAL OBSTRUCTION Presented by:- Amani aziz alrahman

1. INTESTINAL OBSTRUCTIONPresented by:- Amani aziz alrahman

2. Colon atresia Meconium plug Meconium ileus Anorectal malformation Small left colon syndrome Megacystic-microcolon-intestinal hypoperstalsis syndrome

3. Neonatal intestinal obstruction Symptoms: Bilious vomiting Abdominal distention Delay in passing meconium Sign: Visible bowel loops tender on palpation, bowel is palpable Dull on percussion Rectal examination

4. Investigation: X-ray :distended intestinal bowel, multiple fluid level Contrast enema: diagnostic Rectal biopsy Treatment : NPO Nasogastric tube I.V fluids , antibiotics Treat the cause

5. Colon atresia Lest common one of the intestinal atresia , the common site is transverse colon Ischemia in the vascularity of the mesentery necroses of the bowel segment Polyhydraminos Contrast enema is diagnostic obstruction site, and distal atrophy , proximal dilatation Treatment resection of the dilated part and reanastomosis.

6. Meconium plug Mildest and the most common 1\500 to 1\1000 Etiology is not clear No fluid on x-ray Contrast :diagnostic Treatment : rectal stimulation Contrast N.B: observe

7. Meconium ileus 30% of intestinal obstruction, usually present in the first days in life 50% associated with other intestinal problem (volvulus , atresia, perforation ) 15% of patients with cystic fibrosis (AR) P.R: small caliber of rectum, rectum is empty X-ray: ground- glass appearance Contrast enema: empty micro colon, entrapment of meconium in the ileum 50% present with complication (meconium peritonitis, perforation)

8. X-ray: intraperitonial calcification, free air or very large air_ fluid levels Treatment : gastrograffin enema administration Operative evacuation of the obstruction by irrigation

9. In case of complication laprotomy is required terminal ileum is opened wash out the meconium and temporary ileostomy may be required some time intestinal resection and anastomosis

10. Anorectal malformation 1\4000 to 1\8000 Defect in the embryological development Urorectal septum, lateral mesoderm structures and ectodermal structures from the normal rectum and lower urinary tract Anal stenosis 20% of anarectal malformation, anal web Anus appear very small, black dots of meconium P.R: small , tight anus Treatment: dilatation, may be need to continued for several months

11. Anal atresia Male = female Perineal inspection reveals Absent of anus It is divided into high or low Depending on whether the rectum ends above the levator muscle or partially descends through the muscle Low type: rectum ends above the skin

12. In female: the anus open in front of it�s normal position (vestibular anus) High type: rectum ends before levator ani muscle, with no feacal control In male: rectourethral fistula In female: rectovaginal fistula TREATMENT Low type: anoplasty , good prognosis High type: Colostomy at birth, then at 6 months posterior sagittal anorectoplasty, 2 months later close the colostomy

13. Investigation: (invertogram) measure the distant between radioopuqe at anal site and the rectum Draw line from the coccyx to the syumphs pubic (levator muscle) N.B:70% present with associated anomalies 50% urologic, 20% VACTERL

14. Small left colon syndrome Rare cause History of maternal diabetes with abnormal glucose tolerance test in 50% infants how are hypoglycemic septic an association with hypothyroidism, hypermagnesaemia Ass/e maternal use of psychotic medication Dysmotility in the descending colon

15. Contrast study : short colon and lack of tortuosity from the splenic flexure to the anus Rectal biopsy shows present of ganglion cells If it sever it required colostomy

16. Megacystic-microcolon-intestinal hypoperistalsis syndrome Rare cause Megacystic-microcolon-intestinal hypoperistalsis syndrome There is a high number of ganglion cells Megacystis and megaureters Most of the patients die from the complication Contrast enema:

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