Neo-natal Small Bowel Obstruction

Question 1

What is intestinal stenosis and atresia?

Answer 1

This refers to the absence of an opening in a certain part of the intestine (Atresia) or the narrowing of said part (stenosis)
This can either be
- Duodenal or
- Non duodenal (Jejunum and Ileum)

Question 2

What are the causes of duodenal atresia?

Answer 2

• Duodenal stenosis
  
  • Failure of recanilisation in gut formation
  • Associated with trisomy 21 (Down syndrome)

Question 3

1. What clinical features can be expected with duodenal atresia?
2. What are the associated defects of duodenal atresia?

Answer 3

1. Clinical features
   - Bilious vomiting
   - Polyhydramnios (Inc in fluid in amniotic sac)
   - Jaundice
   - Fenesyrated web
2. Associated defects
   - Heart defects
   - Trisomy 21
   - VACTERL association
   > (Vertebral, anorectal, cardiac, trachea, Esophageal, Renal, Limbs).

Question 4

What radiological findings are associated duodenal atresia?

Answer 4

In An erect abdominal x-ray
- Double bubble sign.
(Occluded duodenum fills with amniotic fluid and stomach distends.)
( Two large air-fluid levels with absence of distal air.)

Question 5

What management/ treatment is required in duodenal atresia?

Answer 5

Correction of fluid and electrolyte abnormalities
- IV fluids
Gastric decompression.
- Remove fluid from stomach using a nasogastric tube

DEFINITIVE TREATMENT

• SURGICAL REMOVAL OF AFFECTED SEGMENT.
• Duodenoduodenostomy

Question 6

What is the cause of Jejuno-Ileal atresia’s?

Answer 6

This is a result of intra-uterine ischaemic injury.

• Lack of blood flow to developing gut
• Ischaemic necrosis.
• Destruction of that segment

Question 7

What are the 4 types of jejuno-ileal atesias?

Answer 7

1. Membranous obstruction of lumen.
2. Thin fibrous band- no mesenteric defects
3. Two subtypes
   
   • Large mesenteric defect
   • Apple- peel
4. Multiple Atresias - String of sausages.

Question 8

What are the clinical features of jejuno-ileal atresia?

Answer 8

Polyhydramnois.
Abdominal distention.
Bile-stained vomit.
Jaundice 20%.

Question 9

Name 3 procedures used to manage jejuno-ileal atresia:

Answer 9

Correction of fluid and electrolyte abnormalities
- IV fluids
Gastric decompression.
- Remove fluid from stomach using a nasogastric tube
Surgery
- Resection and anastomosis
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