Neonatal intestinal obstruction

Neonatal Intestinal Obstruction I High Obstruction 2 Low Obstruction 14 Necrotizing Enterocolitis 29 Pneumoperitoneum 34... 

Loening-Baucke V, Kimura K (1999) Failure to pass meconium diagnosing neonatal intestinal obstruction. Am Fam Physician 60 2043-2050... 

In the newborn period the patient may present with a delay or failure to pass meconium, distension of the abdomen, bilious vomiting or signs of neonatal intestinal obstruction. An AXR will show evidence of low obstruction but will be non-specific however, it may allow assessment of the lower spine and in Hirschsprung s disease a lack of air in the distal colon or rectum may he a sign of congenital agan-glionosis (Fig. 6.9a). 

Human urine and meconium Gastric contents from neonates with high intestinal obstruction... 

Clayton et al. found small amounts of 2 tetrahydroxy C27 bile acids along with a number of C24 bile acids in gastric contents from neonates with high intestinal obstruction [110]. One of the higher bile acids was identified as 3a,7a,12 ,25-tetra-hydroxy-5 -cholestan-26-oic acid another was tentatively identified as 3a,7 ,12a,26-tetrahydroxy-5)8-cholestan-27-oic acid by its reduction with lithium aluminum hydride to 5]3-cyprinol (5j8-cholestane-3 ,7a,12a,26,27-pentol) [110]. 

Dihydroxychol-5-en-24-oic acid has been found as a minor bile acid in human meconium [113] and urine [82], and 7a,12a-dihydroxy-3-oxochol-4-en-24-oic acid in gastric contents from neonates with high intestinal obstruction [110]. 

For practical purposes, the differential diagnosis of low intestinal obstruction in the neonate consists of five conditions. Two conditions involve the distal ileum and include ileal atresia and meconium ileus, and three involve the colon, which are colonic atresia, Hirschsprung s disease, and functional immaturity of the colon that includes meconium plug... 

Hahn H, Hoepner F, Kalle T, et al. (1997) Appendicitis in childhood (German). Radiologe 37 454-458 Hajivassiliou CA (2003) Intestinal obstruction in neonatal/ pediatric surgery. Semin Pediatr Surg 12 241-253 Hayakawa K, Hamanaka Y, Suzuki M et al (2003) Radiological findings in total colon aganglionosis and allied disorders. Radiat Med 21 128-134... 

Disorders of the intestinal tract in the neonatal period usually present with abdominal distension and dilatation of the bowel. However, not all intestinal dilatations represent obstruction. Infants with medical disorders such as sepsis, electrolyte imbalance or necrotizing enterocolitis may present ileus characterized by uniform dilatation of the bowel to the level of the rectum. Also, infants on continuous positive airways pressure may swallow an excessive amount of air and exhibit important intestinal dilatation. This dilatation must be distinguished from mechanical obstruction, because the treatment is completely different. The differentiation between these two categories can usually be made on the basis of clinical history, laboratory tests, and appropriate radiographs (Hernanz-SCHULMAN 1999). 

Malrotation is a general term that includes a wide spectrum of anomalies that occur when intestinal rotation and fixation happens in an abnormal way. Failure of completion of the normal intestinal rotation leads to a continuum of anatomic abnormalities with a common clinical denominator consisting of obstruction with the potential for midgut volvulus. Only its presentation as an abdominal emergency in the neonatal period is discussed here. 

Causes of constipation in infants and children include functional constipation, neurogenic constipation [aganglionosis, hypoganglionosis, neuronal intestinal dysplasia (NID)], chronic intestinal pseudo-obstruction, disorders of the spinal cord, cerebral palsy, constipation secondary to anal fissures and strictures, neonatal hypothyroidism and drug induced constipation (Potter 1998). 

Onset of chronic intestinal pseudo-obstruction can be at any age but tends to be more severe with the earlier presentation. In the neonatal period symptoms include failure to pass meconium, abdominal distention or bilious vomiting. Constipation may subsequently develop. In older children presenta-... 

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