Intestinal Obstruction

Question 1

What is intestinal obstruction?

Answer 1

Intestinal obstruction is where a physical obstruction prevents the flow of faeces through the intestines. This blockage will lead to a back-pressure through the gastrointestinal system, causing vomiting. It also causes absolute constipation, where the patient is unable to pass stools or wind.

Question 2

What causes intestinal obstruction?

Answer 2

• Meconium ileus
• Hirschsprung’s disease
• Oesophageal atresia
• Duodenal atresia
• Intussusception
• Imperforate anus
• Malrotation of the intestines with a volvulus
• Strangulated hernia

Question 3

What are the clinical features of bowel obstruction?

Answer 3

Persistent vomiting. This may be bilious, containing bright green bile.

Abdominal pain and distention.

Failure to pass stools or wind.

Abnormal bowel sounds. These can be high pitched and “tinkling” early in the obstruction and absent later.

Question 4

What is the initial investigation of intestinal obstruction?

Answer 4

The initial investigation of choice is an abdominal xray.

Question 5

How does intestinal obstruction present on abdominal xray?

Answer 5

The initial investigation of choice is an abdominal xray.

This may show dilated loops of bowel proximal to the obstruction and collapsed loops of bowel distal to the obstruction. There will also be absence of air in the rectum.

Question 6

Briefly describe the management of intestinal obstruction

Answer 6

Patients presenting with intestinal obstruction need to be referred to a paediatric surgical unit as an emergency. Initial management involves making them nil by mouth and inserting a nasogastric tube to help drain the stomach and stop the vomiting. They will also require IV fluids to correct any dehydration and electrolyte imbalances, and keep them hydrated while waiting for definitive management of the underlying cause.