Bowel obstruction after neonatal period

Question 1

What are the causes of bowel obstruction after the neonatal period

Answer 1

• Intussusception
• Hypertrophic pyloric stenosis
• Malrotation and volvulus
• Post-operative adhesions
• Strangulated/incarcerated inguinal and umbilical hernias

Question 2

What is the presentation of a patient with malrotation with a midgut volvulus

Answer 2

Sudden onset of blood pr
Bilious vomiting
Abdominal distention

• In a previously healthy baby

Question 3

What is the surgical treatment of a volvulus

Answer 3

De-rotate
Cut Ladd’s bands
Broaden mesentary

Question 4

What ar ethe long term complications of a volvulus

Answer 4

Recurrent volvulus
Short bowel syndrome
Adhesive bowel obstruction

Question 5

What is Intussusception and which age and area in the body does it mostly affect

Answer 5

It is an invagination of one part of the intestine into another. Most common cause of haematochezia

Affects mostly ilio-colic, can also be ileo-ilial, colo-colic
Ages 3-18months: 5months peak

Question 6

Explain the pathophysiology of Intussusception

Answer 6

Caused by a lead point which is pulled into the lumen by peristalsis

Age3-9 months: Lead point mostly enlarged bowel lymphoid tissue following viral infection

Older than 9months: Lead points - Meckel’s diverticulum, polyops, lymphoma, worms

Question 7

What are symptoms of Intussusception

Answer 7

A well fed baby with recent history of upper respiratory tract or gastro-entiritis

Bloody, slimy stool
Signs of bowel obstruction: Vomiting, abdominat distention
Intussusception might protrude through anus mimicking rectal prolapse

Question 8

What are the special investigations for Intussusception

Answer 8

Plain abdominal x-ray
Ultrasound
Electrolytes

Question 9

What is the management of Intussusception

Answer 9

Nil per os
Nasogastric tube, IV fluids (rehydratiuon and maintenance

Pneumatic reduction:
- Child fully resuscitated
- Abdomen without peritonitis
- No free air on AXR

Laparatomy:
- If pneumatic reduction contraindicated or failed
- Intraoperatively: Trial of manual reduction
- If reduction fails: Resection

Question 10

What is Meckel’s diverticulum

Answer 10

It is t5he most common vitiline duct abnormality: Omphalomesenteric duct or yolk stalk

Question 11

What are the complications of Meckel’s diverticulum and how is it treated

Answer 11

Ulceration
Perforation
Bowel obstruction
Bleeding

Treated by surgical excision

Question 12

How is Meckel’s diverticulum diagnosed

Answer 12

Technetium 99m scan