1 / 33

Understanding Obstruction versus Ileus in Pediatric Patients: Differentiating for Correct Diagnosis

Learn the differences between obstruction and ileus in pediatric cases, recognizing patterns on abdominal films with 15 examples. Abdominal pain can be challenging to distinguish, but surgical emergencies like obstructions require a high index of suspicion. Explore mechanical obstruction examples like hernia and volvulus, and temporary factors causing adynamic ileus. Understand gas distribution, bowel distension, air-fluid levels, and bowel loop arrangements to aid in diagnosis. Clinical cases and patterns help cement knowledge for better patient care.

rosal
Download Presentation

Understanding Obstruction versus Ileus in Pediatric Patients: Differentiating for Correct Diagnosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Obstruction or Ileus ?Jim LamphearPediatric GI Fellow

  2. Outline • Obstruction versus ileus • How to read an abdominal film • 15 Examples • 1 Case

  3. What Does It Matter? • Abdominal pain is common • Difficult to distinguish • Obstructions tend to be surgical emergencies • Maintain a high index of suspicion if clinical or radiographic data are unclear

  4. Mechanical Obstruction • Impedance of air or intestinal contents due to mechanical forces • Examples: • Incarcerated hernia • Instussusception • Volvulus • Intestinal atresia • Extrinsic compression • Intraluminal mass

  5. “AIM” • Adhesions • Appendicitis • Intussusception • Incarceratedinguinal hernia • Malrotation • Meckel's • Masses

  6. Adynamic Ileus • Temporary impedance of air or intestinal contents due to uncoordinated or decreased peristalsis • Examples: • Gastroenteritis • Abdominal/spinal/pelvic surgery • Inflammation (sepsis, pneumonia, UTI) • Metabolic (hypokalemia, hypothyroid) • Pseudoobstruction

  7. Patterns • Fixed anatomy • Gas distribution • Degree of bowel distension • Air-fluid levels • Arrangement of bowel loops

  8. Fixed Anatomy • Relatively fixed structures • Stomach, duodenum, hepatic/splenic flexures, rectum • Solid organs • Liver, spleen, kidneys, bladder, psoas muscle • Lungs and diaphragm • Bony structures

  9. Gas Distribution • Obstruction • Poor gas distribution or gasless • More air proximal to obstruction • Ileus • Air distributed throughout abdomen • Incompetent ICV or early obstruction

  10. Bowel Distension • Obstruction • Smooth bowel walls (“sausages”) • Dilation proximal to obstruction • Ileus • Dilation remains proportional • Colon is larger than the small intestine • “Sentinel loops” • Short segment of bowel dilation adjacent to inflammation

  11. Air-fluid Levels • Obstruction • Many dilated air-fluid levels in both limbs of a given loop at different heights (“candy canes”) • Ileus • Fewer/smaller air-fluid levels scattered throughout the abdomen

  12. Arrangement of Bowel Loops (supine view only) • Obstruction • Orderly • “Bag of sausages” • Ileus • Disorderly • “Bag of popcorn”

  13. Examples • HPI: Emesis and abdominal pain • PE: VSS, mildly tender Supine Upright

  14. Example #1

  15. Example #2

  16. Example #3

  17. Example #4

  18. Example #5

  19. Example #6

  20. Example #7

  21. Example #8

  22. Example #9

  23. Example #10

  24. Example #11

  25. Example #12

  26. Example #13

  27. Example #14

  28. Example #15

  29. Case #1 • HPI: 11 month male, stomach flu 2 wks ago, now with NB NB emesis x 5 and intermittently fussy over 12 hrs, no stool • PE: T36.5, P118, Wt 50%, non-toxic appearing, well perfused, abdomen soft, flat, active bowel sounds, no masses, testes descended bilaterally, non-tender, no fissure, heme-positive

  30. Intussusception • 2:1 male to female • 3-12 mo of age • Triad: a) episodic pain, b) emesis, c) passage of bloody/mucoid stools • An abdominal mass may be present • Plain films may be normal up to 12 hours after symptom onset

More Related