Causes Of Bowel Obstruction In Children Flashcards
What are the main categories for causes of bowel obstruction in children?
The causes of bowel obstruction in children can be divided into:
• Congenital
• Acquired
• Functional
What are some congenital causes of bowel obstruction in children?
• Bowel atresia and stenosis
• Meconium ileus
• Anorectal malformation
• Duplication cysts
• Volvulus
• Intraperitoneal bands
What are some acquired causes of bowel obstruction in children?
• Necrotizing enterocolitis (NEC)
• Intussusception
• Hypertrophic pyloric stenosis
• Faecaloma/Bezoar/Worms
• Peritonitis
• Post-operative adhesions
• Incarcerated hernias
• Malignancies
• Inflammatory bowel disease
• Tuberculosis
What are some functional causes of bowel obstruction in children?
• Hirschsprung’s disease
• Meconium plug syndrome
• Ileus
What is the most common intestinal worm to cause surgical complications in coastal South Africa?
Ascaris lumbricoides.
What percentage of the world’s population is estimated to be infested with Ascaris lumbricoides?
20%.
Before routine deworming in South Africa, what percentage of children presenting to hospitals had worm eggs in their stool?
70%.
What are the possible clinical problems related to ascariasis?
- Worm bolus intestinal obstruction
- Worms in the biliary tree
- Acute appendicitis
- Acute pancreatitis
- Peritonitis
How does a child with a worm bolus intestinal obstruction typically present?
With a history of colicky abdominal pain (96%), tenderness on palpation (80%), vomiting (bilious ± worms), and possibly a palpable abdominal mass.
What nutritional status is commonly seen in children with worm bolus obstruction?
They are generally malnourished, with 55% being below the 10th percentile.
What percentage of worm bolus obstruction cases show worms on abdominal x-rays?
More than 75%.
What is the typical appearance of worms on an abdominal x-ray in cases of worm bolus obstruction?
A typical pattern of “coiled” worms.
What are the potential complications of worm bolus intestinal obstruction?
Volvulus and perforation.
How are uncomplicated worm bolus obstructions managed?
Conservatively, using the “drip and suck” method, with symptoms usually decreasing within 24-48 hours.
What does the “drip and suck” method involve?
Insertion of a nasogastric (NG) tube, intravenous fluids for rehydration, and correction of the electrolyte profile.
When is surgical management required for worm bolus obstruction?
If conservative management fails or if complications such as volvulus or perforation develop.
What preparations are needed for surgery in worm bolus obstruction?
Continue “drip and suck” and administer broad-spectrum antibiotics.
What is done if necrotic bowel is found during surgery for worm bolus obstruction?
The necrotic bowel is resected.
What precaution should be taken when “milking out” obstructive worms during surgery?
Care must be taken to avoid releasing toxic substances that can damage the bowel.
What is the helminthicide drug of choice for treating Ascaris lumbricoides?
Albendazole
When should albendazole be administered in cases of uncomplicated worm bolus obstruction?
Only after obstructive symptoms have resolved.
When should albendazole be administered in cases requiring surgery?
After the resolution of post-operative ileus to prevent clumping of dead worms within the bolus.
What are gastrointestinal tract duplication cysts?
Rare congenital malformations that are duplicated sections of the GI tract with a smooth muscle coat and mucous membrane lining.
Where can duplication cysts occur within the gastrointestinal tract?
Anywhere from the base of the tongue to the anus.
How are duplication cysts named?
According to the organs with which they are associated.
How are foregut duplication cysts categorized?
Based on embryonic origin into oesophageal, bronchogenic, and neuroenteric cysts.
When is the abnormal budding of the embryonic foregut thought to occur, leading to duplication cysts?
At 5-8 weeks of gestation.
What are the most common locations for gastrointestinal tract duplication cysts?
Ileum, oesophagus, and colon.
What are the two types of duplication cysts, and how common are they?
Cystic (80%) and tubular (20%)
How can duplication cysts relate to the bowel lumen?
They may communicate with the lumen or be totally separate from it.
Can duplication cysts be intrinsic or extrinsic to the gastrointestinal tract wall?
Yes, they may be contained within the wall or extrinsic to it.
When are duplication cysts usually detected?
Prenatally on ultrasound or in the first years of life when they become symptomatic.
What factors influence the clinical presentation of duplication cysts?
Size, location, type, mucosal pattern, and presence of complications.
What symptoms may intestinal duplication cysts produce?
Nausea, vomiting, abdominal distention, palpable abdominal mass, and recurrent abdominal pain.
What is a common cause of recurrent abdominal pain in duplication cysts?
High pressure inside the cyst due to mucus accumulation.
What is the primary imaging modality used to diagnose duplication cysts?
Ultrasound.
What is the characteristic ultrasound appearance of a duplication cyst?
A “tram track” appearance with an inner hyperechoic epithelial lining and an outer hypoechoic smooth muscle layer.
What creates the “tram track” appearance on ultrasound in duplication cysts?
The inner hyperechoic mucosal lining and the outer hypoechoic smooth muscle layer.
Which additional imaging modalities can be helpful for duplication cysts besides ultrasound?
Magnetic Resonance (MR) and Computed Tomography (CT).
What is the treatment of choice for duplication cysts?
Surgical removal of the cyst.
What factors guide the surgical approach to duplication cysts?
Site, size, common wall attachment, and presence of complications
In some cases, what part of the duplication cyst may be removed instead of the entire cyst?
Only the mucosa.
What are duplication cysts?
Rare congenital anomalies of the digestive tract with unknown aetiology.
What is the most common site for duplication cysts?
Distal ileum.
What is the preferred diagnostic modality for duplication cysts?
Ultrasound (usually antenatal).
Why is surgery necessary for duplication cysts?
To avoid complications.
Why can duplication cysts present in many different ways?
Due to variations in size, location, type, mucosal pattern, and associated complications.
What are postoperative intra-abdominal adhesions?
Fibrous bands that form between abdominal tissues and organs after surgery.
Are postoperative adhesions common after abdominal surgery?
Yes, they are almost inevitable, but the extent and severity can vary.
How common is adhesive bowel obstruction in the pediatric population?
It is considered relatively rare.
What is the typical management technique for adhesive bowel obstruction in adults?
The “drip and suck” technique.
Why is the “drip and suck” technique less effective in pediatric patients with adhesive bowel obstruction?
The outcomes are variable, and surgical adhesiolysis is often required.
What is a common consequence of surgical adhesiolysis for adhesive bowel obstruction?
A high rate of adhesion reformation.
What is a key part of the history when diagnosing adhesive bowel obstruction in children?
A history of an abdominal procedure, usually within the past 5 years.
What are the typical symptoms of adhesive bowel obstruction?
Cramping abdominal pain, vomiting (initially feeds, then bile-stained, later feculent), increasing abdominal distension, and decreasing flatus and stool per rectum.
What type of bowel sounds are associated with adhesive bowel obstruction?
Tinkling bowel sounds.
How do tinkling bowel sounds and typical history help in diagnosis?
They help distinguish adhesive bowel obstruction from ileus due to other causes.
What does an abdominal X-ray (AXR) show in cases of adhesive bowel obstruction?
Multiple dilated loops of bowel appearing as “tubes” rather than “cubes” of air, with possible air-fluid levels on an erect film.
What is the initial management for a patient with adhesive bowel obstruction?
Resuscitation if in shock, correction of electrolyte abnormalities, and full rehydration.
What is the purpose of placing a nasogastric tube (NGT) in adhesive bowel obstruction management?
To decompress the stomach and prevent further distension.
What does “NPO” stand for in the management of adhesive bowel obstruction?
Nil Per Os (nothing by mouth).
When is surgery indicated in adhesive bowel obstruction?
If the obstruction does not resolve after correcting physiological disturbances.
What are the surgical steps in managing adhesive bowel obstruction?
Operative adhesiolysis, resection of necrotic bowel (if present), and re-establishment of bowel continuity.
What does post-operative care involve after surgery for adhesive bowel obstruction?
Supportive care until bowel function returns
Other causes discussed elsewhere in these notes:
• Bowel atresia and stenosis
• Anorectal malformation
• Meconium ileus, Meconium plug syndrome
• Hirschsprung’s disease
• NEC
• Hypertrophic pyloric stenosis
• Intussusception
• Volvulus
• Incarcerated hernias
• Malignancies
What congenital abnormalities can cause bowel obstruction?
Bowel atresia and stenosis, anorectal malformation, meconium ileus, and Hirschsprung’s disease.
What are some functional or motility-related causes of bowel obstruction?
Meconium plug syndrome and Hirschsprung’s disease.
What are some acquired causes of bowel obstruction in neonates and infants?
Necrotizing enterocolitis (NEC), intussusception, volvulus, and incarcerated hernias.
What gastrointestinal condition characterized by thickened pyloric muscle can cause obstruction?
Hypertrophic pyloric stenosis.
What is a rare but possible cause of bowel obstruction related to abnormal cell growth?
Malignancies
