SURGICAL CAUSES

Intestinal atresia :duodenal, jejunal & ileal Intestinal malrotation with volvulus Meconium ileus Neonatal necrotising enterocolitis(NNEC) Hirschprungs disease Anorectal malformations

MEDICAL CAUSES
NEONATAL SEPSIS MATERNAL HYPOTHYROIDISM MATERNAL DIABETES MELLITUS

MATERNAL DRUG ABUSE(ANTI

EPILEPTIC DRUGS)

INTESTINAL ATRESIA

DUODENAL ATRESIA
25-50% of all intestinal atresias Complete stenosis of second part of duodenum at the

level of ampulla of vater Defective fusion of foregut and midgut with failure to recanalise lumen after solid phase of int. develop in 4th &5th weeks of gestation. Associated with downs syndrome & maternal polyhydramnios.

3 TYPES
MUCOSAL BLOCK
TIGHT BAND FIBROSAL

 Obstruction can occur due to annular pancreas or from

ladds band in case of malrotation Associated anomalies-malrotation, esophageal atresia,CHD, anorectal malformations

Clinical features
jaundice bilious vomiting dehydration growth retardation

 Diagnosis:

BABYGRAM: double bubble sign with absence of air in the distal part

Duodenal atresia

TREATMENT
PRE OPERATIVE PREPRATION

correction of fluid & stabilising patient nasogastric or orogastric decompression evaluate for other congenital anomalies Surgical: duodenoduodenostomy Gastrotomy tube or transanastomotic nasojejunal tube for feeding is needed as prolonged post operative ileus is the usual problem

JEJUNAL & ILEAL ATRESIA

TYPE 1

20% membraneous or mucousal atresia TYPE 2 35% fibrous atresia TYPE 3A 35% compelete single atresia TYPE 3B 5% compelete jejunal atresia with coiled ileum(APPLE PEAL) TYPE 4 5% Multiple segments of atresia

TREATMENT
ILEAL\JEJUNAL ATRESIA Stabilise & correct fluid electrolyte balance Prophylactic antibiotics Surgery: resection of dilated proximal bowel with end to end anastomosis In simple mucosal diaphragm- jejunoplasty or ileoplasty with partial excision of web

MECONIUM ILEUS
90% cases associated with cystic fibrosis Thick meconium get collected in

terminal illeum ->insissipated meconium ->obstruction

Clinical features
bilious vomiting
respiratory dysfunction high salt in the sweat Exocrine pancreatic insufficiency

Diagnosis:
Plain x ray- calcified meconium pellets with multiple air fluid levels which appear as soap bubbles (NEUHAUSER SIGN)

MULTIPLE AIR FLUID LEVELS

TREATMENT
In uncomplicated, hyperosmolar contrast media like

gastrografin wash out inspissated meconium Plug is releived by direct enteral irrigation with Nacetyl cysteine following enterotomy. In complicated cases: CHIMNEY ENTEROSTOMY BISHOP KOOP operation SANTULLI operation

SANTULLI OPERATION

Proximal ileum is brought as ileostomy .distal ileum sutured to proximal ileum

BISHOP KOOP OPERATION

Distal ileum is brought as ileostomy and proximal part is sutured to distal bowel

INTESTINAL MALROTATION WITH VOLVULUS

Incomplete rotation of intestine during fetal

development

 Duodenojejunal flexure-right Colon in left side, caecum in midline

Narrow base for small bowel mesentry

Mesentry &sup mesentric artery tethered by narrow

stalk twist around itself causing mid gut volvulus

CLINICAL FEATURES
presents in 1st yr of life with acute or chronic

obstruction Mid gut volvulus with features of strangulation,perforation

Diagnosis
Upper git contrast studies(malrotation),
Barium enema-

Cork screw appearance Malrotation of caecum

TREATMENT
Resuscitation & urgent surgery needed to untwist volvulus, Ladds procedure widen the base of small bowel mesentry, straighten duodenum and position the bowel in a non rotated position Appendicectomy to be done

NECROTISING ENTEROCOLITIS

NECROTISING ENTEROCOLITIS
Rapidly progressing extensive bowel necrosis,

infection & perforation. Common site is terminal ileum,caecum, ascending colon Etiology unknown Predisposing factors- prematurity & pulmonary disorders.

CLINICAL FEATURE
Abd distention
Bloody stools

 Xray abd Air in portal vein

&pneumatocele intestinalis(gas in the bowell wall)

TREATMENT
MEDICAL THERAPY:
BROAD SPECTRUM ANTIBIOTICS, NASOGASTRIC ASPIRATION