INTESTINAL OBSTRUCTION

1. INTESTINAL OBSTRUCTION By: Brig MushahidAslam “Neither sun shall rise nor set on patient of intestinal obstruction”

2. Sequence • Duodenal Atresia • Jejuno-ilealAtresia • MeconiumIleus

3. Definitions • Agenesis absence of organ or primordium • Aplasia absence of organ due to failure of primordium • Atresiaabsence of an opening • Hypoplasia incomplete development of an organ • Hyperplasia overdevelopment of an organ • Dysplasia abnormal cell organization

4. Duodenal Atresia • 1: 5000 • Associated Anomalies • Down’s Syndrome 30 % • Congenital Heart Diseases • Malrotation • Anorectal Malformations

5. Congenital Atresia of the Small Intestine “Vascular Accidents” blood supply to a region of the bowel is compromised and a segment “dies”, resulting in narrowing or complete loss of that region 50% a region of the bowel is lost 20% a fibrous cord remains 20% narrowing, with a thin diaphragm separating the larger and smaller pieces of bowel N.B. stenoses (5%) and multiple atresias (5%) account for the remaining defects

6. Presentation • Antenatal • USG • Polyhydramnios • Distended stomach and 1st part Duodenum • Newborn • Feeding Intolerance • Bilious Vomiting • Scaphoid Abdomen • Failure to pass Meconium

7. Association

8. Types Type I： Complete membrane obstructing the lumen Type III： blind-ending pouch with no connection to the distal duodenum Type II： A pouch with a fibrous cord connecting to the distal duodenum

10. Investigations

11. Management • NPO • Nasogastric aspiration • Intravenous fluids • Antibiotics • Surgery

12. 5’ Hs • Hypothermia • Hypoxia • Hypovolemia • Hypoglycaemia • Hypoprothrombinaemia

13. Management

14. Management

16. Jejuno-ilealAtresia • 1/2000 • Vomiting • Abdominal Distension • Failure to pass meconium

17. Pathogenesis • Mesenteric vascular accidents during early embryologic development  infarction organization + resorption of the necrotic segment • The bowel segment distal to the atresia may contain meconium, indicating previous continuity of the intestine

18. Types

19. Types

20. Types “APPLE PEEL” ATRESIA CONGENITAL MIDGUT ATRESIA

21. Investigations

22. Management

23. Management

24. MeconiumIeus • 30 % intestinal obstruction • Associated Anomalies • Cystic Fibrosis 15% • Atresia • Malrotation

25. Presentation • Newborn • Feeding Intolerance • Bilious Vomiting • Abdominal Distention • Failure to pass Meconium

26. Investigations

29. Treatment • Hypertonic Enema Washouts • Gastrograffin 25-50 % • Effective 30-60 % cases • N-Acetyl cysteine 10 %

30. Management