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Neonatal Intestinal Obstruction: - Coggle Diagram
Neonatal Intestinal Obstruction:
Definition & Causes:
Neonatal intestinal obstruction is a blockage in the intestines present at birth. Major causes include:
Intestinal atresia (failure of intestinal canalization).
Malrotation with midgut volvulus (twisting of the intestines).
Anorectal malformations, Hirschsprung’s disease, meconium ileus, strangulated inguinal hernia, and neonatal intussusception.
Intestinal Atresia:
Etiology: Caused by intrauterine vascular accidents leading to interrupted intestinal lumen.
Levels: Duodenal, jejunal, ileal (most common), and colonic.
Types of Atresia:
Type I: Lumen blockage with intact bowel continuity; no mesenteric defect.
Type II: Blind ends connected by a fibrous cord; no mesenteric defect.
Type III: Blind ends with a V-shaped mesenteric defect; Type IIIb ("apple peel" deformity).
Type IV: Multiple segment atresias.
Signs & Investigations:
Physical exam: Distended abdomen; rectal exam may reveal only mucus.
Lab tests: CBC, electrolytes, coagulation profile.
Imaging:
X-ray:
Double bubble sign (duodenal atresia).
Air-fluid levels (jejunal/ileal atresia).
Air under diaphragm (indicates perforation).
Contrast study: Locates obstruction level.
Clinical Symptoms:
Failure to pass meconium (first stool).
Bilious vomiting (greenish due to bile).
Abdominal distension (except scaphoid abdomen in duodenal atresia).
Pre-Operative Preparation:
NPO (nothing by mouth), NG tube for decompression.
IV fluids, antibiotics, and electrolyte correction.
Stabilization with monitoring.
Surgical Treatments:
Duodenal atresia: Duodeno-duodenostomy or duodeno-jejunostomy (bypass).
Jejunal/Ileal atresia: Resection of atretic segment with end-to-end anastomosis.
Colonic/terminal ileal atresia: Temporary stoma if neonate is unstable, followed by later reconstruction.
Complications:
Gut perforation (requires emergency intervention).
Electrolyte imbalances, sepsis, or short bowel syndrome post-resection.
Differential Diagnoses:
Malrotation with volvulus (emergency due to risk of bowel necrosis).
Hirschsprung’s disease (absent ganglion cells causing functional obstruction).
Meconium ileus (often linked to cystic fibrosis).
Early diagnosis via imaging (X-ray/contrast studies) is critical.
Surgery is definitive treatment, tailored to obstruction type and neonatal stability.
Pre-operative stabilization (fluids, NG decompression) improves outcomes.