High intestinal obstruction in children. Acute intestinal obstruction in a child. Symptoms of intestinal obstruction in newborns

The problem can be eliminated with surgery, but sometimes it is effective conservative therapy. The higher the blockage occurs, the more difficult treatment. The prognosis depends on the timeliness of diagnosis.

Kinds

Intestinal obstruction in children can be congenital or acquired. In the first case, symptoms appear in the newborn after a short time after birth. The course of the disease depends on the degree of blockage.

If intestinal obstruction in a baby is not diagnosed in time, this can lead to intestinal rupture and peritonitis.

The acquired form is most often diagnosed in infants aged 4 months to one year.

Classification depending on the mechanism of formation:

Dynamic. Occurs when intestinal motility is disrupted and mesenteric circulation slows down. It can be spastic (with prolonged intestinal tension) and paralytic (with relaxation of the intestine).
Mechanical. Occurs when there is a physical blockage of the intestines, e.g. foreign body, worms, tumor.

According to the degree of obstruction:

Full. Poses a threat to the child's life. The baby cannot have a bowel movement and emergency surgery is required.
Partial. The intestinal lumen is not completely closed.

According to the level of intestinal involvement:

Low. The blockage occurs in the small intestine, ileum, or colon.
High. Occurs when the duodenum narrows.

According to the nature of the flow:

Spicy. This form is characterized by pronounced symptoms.
Chronic. This form develops with high obstruction. Symptoms increase slowly, pain is minor.

Causes

Causes of congenital intestinal obstruction in a child:

malformations of the intestine during the embryonic period;
pathologies of other gastrointestinal organs.

The blockage is formed at the stage of intrauterine development.

Causes of acquired intestinal obstruction in a child:

poor circulation in the intestine;
stagnation feces in infants (meconium ileus);
formation of adhesions in the intestines;
blockage of the intestine by a tumor, foreign body, helminths, lump of food;
intestinal diverticula;
hernia in abdominal cavity;
twisting or bending of the intestines;
intussusception (a condition in which the intestines fold in on themselves);
overeating due to prolonged fasting;
impaired peristalsis due to immaturity of the gastrointestinal tract;
complication after surgery on the abdominal organs;
long-term use of medications.

Symptoms

Symptoms of intestinal obstruction depend on the nature of the course and the degree of blockage. For acute form The following symptoms are typical:

the child feels severe pain in the abdomen, which can last from 2 to 12 hours;
after painful sensations subside a little, signs of gastrointestinal dysfunction appear (bloating, flatulence, constipation);
after a day, the pain becomes unbearable, and the child’s condition worsens.

With chronic intestinal obstruction, cramping pain appears after eating. Babies are bothered by constipation and frequent vomiting.

In children under one year old

Infants are not able to describe their complaints, so parents need to carefully monitor the baby’s condition.

Symptoms of intestinal obstruction in infants:

There is acute pain and spasm in the abdomen. The child cries and clenches his legs. He cannot sit still, he tries to take a position in which the painful sensations. After a while, the baby suddenly stops crying. The attacks may recur after 15-30 minutes.
Stool mixed with blood and mucus. Evacuation occurs after crying.
Lack of appetite.
Vomiting after an attack. Vomit may be mixed with bile.
Bloating and lack of stool (with complete blockage of the intestine). Partial blockage may result in diarrhea.

If treatment is not sought immediately, newborns may develop a fever.

In children after one year

The manifestations are:

attacks of cramping pain;
lack of appetite;
nausea and regular vomiting;
stool retention, problems with bowel movements.

With excessive vomiting, symptoms of dehydration occur.

Which doctor treats intestinal obstruction in children?

It is necessary to contact a pediatric gastroenterologist and surgeon.

Diagnostics

The diagnosis of “intestinal obstruction” in children is made on the basis of the following examination:

Examination of the child. The doctor palpates the abdomen. During palpation, swelling and pain are detected. A lump may be felt in the abdomen.
X-ray of the abdominal cavity.
Ultrasound. Is over informative method diagnostics rather than x-rays.
Air or barium enema. Air or barium is injected into the rectum. With intussusception, this technique is not only diagnostic, but also treatment.

Treatment

Intestinal obstruction in newborns is best treated in the surgical department.

Before the baby is given an accurate diagnosis, there is no need to do an enema, give a laxative or rinse the stomach.

Treatment is carried out only after full examination. It can be conservative or operative.

In the absence of complications, therapy consists of eliminating the symptoms of intoxication and removing intestinal blockage. The set of events looks like this:

To stop an infant from vomiting nasal cavity a probe is inserted to remove congestion in the upper sections digestive tract.
With severe peristalsis, the baby is given antispasmodics.
Painkillers and antiemetics are prescribed.
To restore the water-salt balance, solutions are administered intravenously.
In case of intussusception, an air enema is given during the day. This procedure allows you to get rid of intestinal obstruction in newborns in 50-90% of cases.
A rectal tube can help treat volvulus.

In case of complete obstruction, surgery cannot be avoided. A bowel resection is performed (the affected area is removed).

Prevention

In most cases, it is impossible to prevent intestinal obstruction. The only preventative measure is proper nutrition. Must be included in baby's diet dairy products, fresh fruits and vegetables, prunes and dishes with high content fiber.

The prognosis is favorable if help is provided to the baby in a timely manner. If not diagnosed in a timely manner, intestinal obstruction can cause infection and death of the baby.

Useful video about acute intestinal obstruction

P76.9 Intestinal obstruction in newborn, unspecified

Epidemiology

Prevalence statistics indicate that intestinal obstruction is frequent illness- about 10% in the structure acute diseases The abdominal cavity is occupied by this particular pathology. In 0.1 - 1.6% it complicates the course of the postoperative period in sick children who have undergone surgery on the abdominal organs in the neonatal period. The pathology is somewhat more common in boys. The mortality rate for this pathology ranges from 5 to 30% and strongly depends on the gestation and age of the newborn. If acute intestinal obstruction occurs in the early postoperative period reaches 16.2 - 60.3%, and depends on timely diagnosis, timing of surgical treatment.

Causes of intestinal obstruction in newborns

Intestinal obstruction is a syndrome that complicates the course of many diseases and conditions. The pathophysiological link is a violation of the movement of chyme along the digestive canal, which in turn completely or partially disrupts the motor function of the intestine. There can be many reasons for this, but disruption of normal intestinal function is one of the most important factors.

To understand all the reasons for the development of obstruction, you need to know some types of this pathology. There are strangulation, obstructive, spastic and paralytic obstruction. Accordingly, there are different reasons for this.

Obstructive obstruction occurs as a result of coprostasis or intestinal tumors, which is much less common in newborns. Coprostasis is caused by congenital Hirschsprung's disease, colon stenosis, which is accompanied by intestinal atony. This makes contraction and intestinal motility difficult even from the very birth of the baby. This leads to the fact that such children suffer from constipation, and coprolites (small fecal stones) are formed from feces. Such coprolites can completely obstruct the lumen of the intestinal tube and cause intestinal obstruction.

Strangulated intestinal obstruction develops against the background of Meckel's diverticulum, internal hernias, especially clinically significant diaphragmatic hernias. Such pathologies often lead to increased intestinal motility, and especially in newborns, the intestinal mesentery is very mobile. This easily leads to pinching of the intestinal wall and some external strangulation occurs.

Most common reasons Intestinal obstruction in newborns is a disease of other organs. They underlie the so-called paralytic obstruction. The reasons for this may be the following:

medicines, especially narcotic drugs, which influence muscle wall intestines;
an infection of the abdominal cavity weakens not only motility, but also other intestinal functions;
mesenteric ischemia against the background congenital pathologies vessels of the descending aorta or mesenteric arteries;
complications of abdominal surgical interventions;
kidney and organ diseases chest cavity;
metabolic disorders (hypokalemia);
necrotizing enterocolitis in newborns;

Often such obstruction occurs against the background of birth trauma, functional immaturity of the digestive tract, pneumonia, sepsis, and peritonitis. These pathologies cause a reaction internal organs in the form of centralization of blood circulation, which causes ischemia of the intestinal wall. Peristalsis is also impaired due to intoxication, especially in newborns due to the immaturity of the mechanisms for coordinating this function. This leads to intestinal paresis and subsequent development of obstruction.

Intussusception is distinguished separately, since with this type of obstruction there are elements of obstruction and strangulation. Intussusception is a special type of acquired obstruction in children. early age, the essence of which is that the proximal segment of the intestine is wedged into the distal one. Subsequently, the blood supply to the intestine is disrupted, which leads to its necrosis.

There are small-small intussusception, ileocecal type (90%), very rarely large-colic (1-3%) intussusception. In the area where intussusception occurs, a tumor-like formation is formed, which consists of three layers of the intestinal wall: the outer, into which the intussusception is wedged, the middle and the inner. The mesentery of the intestine is pinched between these walls of the intussusception. It depends on the degree of pinching clinical course diseases - with mild strangulation, the symptoms of the obstructive process predominate, the disease proceeds easily, intestinal necrosis does not occur. In cases of severe strangulation, signs of strangulation intestinal obstruction predominate, bloody stools and necrosis of the intussusception quickly appear. Ileocecal intussusception occurs more easily than small-intestinal intussusception. After the phase venous stagnation As a rule, swelling quickly increases, stagnant bleeding occurs, and bloody effusion appears in the abdominal cavity. Due to the progressive disruption of blood supply, necrosis of the intussusception occurs.

Pathogenesis

The pathogenesis of changes in obstruction does not depend on its type, but depends on a local stop in the movement of food through the intestines. This causes further changes that underlie the development of symptoms.

In the area of the pathological source in the intestine, integrity and permeability are impaired blood vessels and the peritoneum itself, providing ultrafiltration of plasma and tissue fluid. This leads to plasma proteins containing inactive components of the blood coagulation system leaving the vascular bed and peritoneum into the abdominal cavity. These substances, upon contact with the damaged peritoneum and tissues of the abdominal organs, are activated, a cascade coagulation reaction occurs, which ends with the deposition of fibrin on the surface of the abdominal organs. This is facilitated by tissue coagulation factors contained in the tissue cells of the abdominal organs and peritoneal mesothelium. Fibrin, deposited on the surface of the abdominal organs, has adhesive properties and fixes adjacent organs. This leads to the fact that in the place where the food stopped, the layers of the intestine, as well as the mesentery, become even more sticky. This completely disrupts the movement of chyme and is the main mechanism of the pathogenesis of intestinal obstruction in a newborn.

Symptoms of intestinal obstruction in newborns

Symptoms of intestinal obstruction in newborns do not depend on the type, since the pathogenetic features of the pathology are not particularly different. The stages of development of disorders in intestinal obstruction proceed sequentially from circulatory disturbances in a certain area of the intestine to its necrosis. Considering that in newborns the intestinal wall is very thin, the period for the development of symptoms is reduced. When intestinal necrosis occurs, the whole process ends in peritonitis.

The first signs of acute intestinal obstruction begin suddenly and are characterized by great polymorphism clinical manifestations. The process quickly leads to severe intoxication, changes in homeostasis, and causes various complications pathological process and worsens the patient's condition.

Classical clinical picture Intestinal obstruction in a newborn is characterized by a sudden onset against the background of complete health. Pain in the intestines gradually arises, which is characterized by attacks of anxiety in newborns with the gradual addition of toxicosis.

Vomiting is one of the obligatory symptoms of this disease in newborns. With severe intestinal obstruction, vomiting appears on the first day of life after birth. Depending on the level of damage, the nature of vomiting may vary.

Thus, in conditions of complete obstruction, the vomit will have the appearance of curdled milk without bile impurities. If the process is localized slightly lower at the level of the distal parts small intestine, then the vomit will be digested milk.

The nature of the newborn's stool also changes. With high obstruction, almost normal meconium will pass, normal in quantity and color. If the process of obstruction is slightly lower, then the meconium is practically not colored. There may also be bloody discharge from the rectum or streaks of blood in the baby's stool.

The general condition of newborns from the onset of the disease is satisfactory, but quickly

Exicosis and symptoms of malnutrition progress against the background of repeated vomiting and diarrhea. Dryness appears skin, sunken eyes, fontanel, decreased tissue turgor. Later, swelling of the epigastrium is noted, which decreases after vomiting.

The clinical picture of paralytic intestinal obstruction is characterized by sudden swelling abdomen, symptoms of intoxication, retention of stool and gases. Since the paralytic focus is wider than with other types of obstruction, the bloating of the child’s tummy is very pronounced. This can disrupt the breathing process, which in turn is a prerequisite for the development of hypoxia and hypostatic pneumonia.

Body temperature does not rise often; intoxication phenomena are often accompanied by dehydration and electrolyte disturbances.

Congenital intestinal obstruction in a newborn has the same manifestations, but they appear immediately after the birth of the child. Vomiting, impaired passage of meconium, bloating - all these symptoms begin to appear within a few hours after birth.

Partial intestinal obstruction in a newborn is characterized by disorders in which the intestinal cavity is only half blocked. Therefore, the symptoms do not develop so acutely and they must be carefully differentiated from functional disorders in newborns.

Complications and consequences

The consequences and complications of intestinal obstruction can be very serious. Considering intestinal necrosis in the absence timely treatment, then one of the most common consequences is peritonitis. Longer-term consequences may develop if surgical treatment. In this case, dense adhesions often form, which can lead to repeated obstructions in the future. Persistent functional disorders intestinal problems in children in the future - this is one of the common consequences of intestinal obstruction. If newborns with obstruction have other concomitant pathologies, the risk of mortality increases, including fatal complications.

Diagnosis of intestinal obstruction in newborns

Diagnosis of intestinal obstruction in newborns must necessarily be based on a thorough examination of the baby. After all, vomiting and stool disorders are nonspecific symptoms, which are characteristic not only of intestinal obstruction.

It is imperative to examine the abdomen of a newborn child if any intestinal pathology is suspected.

When intussusception occurs against the background of intestinal manifestations, there are other local symptoms. A tumor-like formation with a doughy consistency is palpated, which can change its position when pressed. With paralytic obstruction, the abdomen looks sharply swollen and soft on palpation. Percussion reveals high tympanitis; auscultation reveals no peristaltic sounds. The normal process of motility is disrupted, so no noise is detected.

The tests that are necessary to diagnose obstruction are not specific, so at the initial stages they are limited to only general tests.

Instrumental diagnostics is the main and priority method for confirming the diagnosis of obstruction. X-ray examination allows you to determine the level of obstruction and degree, because gases and food accumulate above the level of the obstruction, and below there are no signs of normal motor skills. X-ray examination helps to verify changes characteristic of high intestinal obstruction: pronounced accumulation of air in upper sections intestines and determining the level of liquid under these gases. The intestinal loops are arranged in such a way that they form “arcades”, which look like garlands, filled half with air and half with liquid. Normal bowel has a clear distribution and location of loops.

Differential diagnosis

Differential diagnosis needs to be carried out with congenital anomalies intestines, esophageal atresia, pyloric stenosis. All these pathologies are symptomatically very similar, but a careful examination can determine the diagnosis.

Treatment of intestinal obstruction in newborns

If intestinal obstruction is suspected, treatment of the child in a hospital is mandatory. Therefore, if repeated vomiting or stool disturbance occurs, it is necessary to hospitalize the newborn if he was previously at home. If a newborn begins to have similar problems immediately after birth, it is imperative to consult a surgeon.

During the first 1.5-2 hours after the child’s hospitalization in the hospital, complex conservative therapy is carried out. Such treatment has differential diagnostic significance and, by its nature, can be preoperative preparation.

Therapy is aimed at preventing complications associated with painful shock, correction of homeostasis and at the same time represents an attempt to eliminate intestinal obstruction using non-operative methods.

Measures aimed at combating abdominal pain shock include: neuroleptanalgesia (droperidol, fentanyl), perinephric novocaine blockade and administration of antispasmodics (baralgin, spasmoverine, spasfon, no-shpa). In children, the use of some drugs may be limited during the neonatal period, so treatment is carried out with the obligatory consultation of a pediatric anesthesiologist. Pain management is carried out after the diagnosis has been established.
Elimination of hypovolemia with correction of electrolyte, carbohydrate and protein metabolism is achieved by the introduction of salt blood substitutes, 5-10% solution of glucose, gelatin, albumin and blood plasma. All calculations are carried out taking into account the fluid needs of the newborn baby’s body, and in addition, the needs for nutrients are also taken into account.
Correction of hemodynamic parameters, microcirculation and detoxification therapy is carried out using intravenous infusion rheopolyglucin, reogluman or neohemodez.
Decompression of the gastrointestinal tract is carried out using nasogastric tube. A child with a confirmed diagnosis of intestinal obstruction should be transferred to full parenteral nutrition. Feeding of the child is prohibited and all substances are calculated based on body weight. At the time of treatment, enteral nutrition is completely prohibited; from the moment of recovery, breastfeeding is gradually introduced.
When treating paralytic obstruction, it is necessary to treat the underlying disease that caused the paresis. In addition, drug stimulation of intestinal motility is carried out with proserin and infusion solutions.

When there is obstruction, gradual necrosis necessarily occurs in this part of the intestine with the absorption of decay products and intoxication. This is always a prerequisite for the proliferation of bacteria, therefore, regardless of the treatment method, for intestinal obstruction it is used antibacterial therapy. Only spastic and paralytic obstruction is treated conservative methods few hours. All other types of obstruction should be treated by surgery without delay. In this case, initial antibacterial and infusion therapy is carried out for two to three hours, which is preoperative preparation.

Sulbactomax is an antibiotic combined composition, which consists of the 3rd generation cephalosporin ceftriaxone and sulbactam. This composition makes the antibiotic more stable and is not destroyed by bacteria. This remedy is used for treatment in combination with other drugs. Method of administration: intravenous for more fast acting. The dosage of the drug is 100 milligrams per kilogram of body weight. Side effects come in the form allergic reactions, renal dysfunction, effects on the liver.
Kanamycin is an antibiotic from the macrolide group, which is used for newborns in the treatment of intestinal obstruction as preoperative preparation, and in the postoperative period to prevent complications. The dosage of the drug is 15 milligrams per kilogram of body weight per day for the first three days, then the dose can be reduced to 10 milligrams. Method of administration - intravenous or intramuscular, divided into 2 doses. Side effects may include: irreversible violations hearing, as well as toxic effects on the kidneys.

When the child’s condition is stabilized, mandatory surgery. Surgery Intestinal obstruction is carried out necessarily in case of obstructive and strangulation type. Since in these types there is an obstacle of a mechanical nature, it is only possible to restore normal intestinal function medications it won't work.

All parents are certainly familiar with the phenomenon of abdominal pain in a child. Most often, these pains in babies are associated with intestinal spasms and quickly pass spontaneously or with a light massage (stroking) of the abdomen. However, you should not be careless about your child’s illness and think: “It will go away on its own!” Sometimes abdominal pain is a symptom of such a serious disease as intestinal obstruction.

Acute intestinal obstruction is understood as a violation or complete cessation of the movement of the contents of the digestive tract through the intestines.

Classification

The cause of intestinal obstruction may be intussusception.

Intestinal obstruction can develop in a child of any age, including a newborn.

Intestinal obstruction can be:

congenital and acquired;
high and low;
full and partial;
obstructive (due to the closure of the intestinal lumen by any formation);
strangulation (due to compression of a section of the intestine);
dynamic.

Causes of intestinal obstruction

The causes of intestinal obstruction in children can be:

congenital pathology of the digestive canal;
volvulus;
intussusception (invasion of one part of the intestine into another with closure of the lumen);
adhesions in the abdominal cavity;
in the abdominal cavity and intestines;
coprostasis (accumulation of feces in the intestines);

Congenital intestinal obstruction associated with malformations of the digestive tract: elongation of a section of the intestine (usually the long sigmoid colon) or narrowing of its lumen.

One of the variants of congenital narrowing of the lumen is pyloric stenosis: narrowing of the sphincter at the border of the stomach and intestines. Pyloric stenosis makes it difficult for milk to enter the intestines and already in the first 2 weeks of the baby’s life it manifests itself in profuse vomiting in the form of a fountain.

In infants, the causes of obstruction may include individual atypical location of the intestine or torsion of its loops.

In newborns, another form of intestinal obstruction may occur: meconium ileus . He is an option obstructive obstruction: the intestinal lumen is blocked by meconium, high-viscosity feces of a newborn.

Coprostasis, or the accumulation of feces in the intestinal lumen, can lead to obstructive intestinal obstruction in older children. The cause of coprostasis is a decrease in the tone of the intestinal wall and impaired peristalsis. It can also be observed with a congenital defect: an elongated sigmoid colon. Coprostasis can block the lumen of the end portion of the small intestine or large intestine.

In infants and newborns, this functional inferiority of the digestive tract can occur after birth trauma, against the background, after surgery on the abdominal and thoracic organs, with intestinal infections. At older ages, it often develops with serious illnesses due to toxic effects (for example, in sepsis) and in the postoperative period.

Depending on the severity, obstruction can be complete or partial. At partial obstruction, the intestinal lumen is narrowed, but not completely blocked (for example, with dynamic obstruction) or blocked by some obstacle, but not yet completely. The intestine remains partially permeable to intestinal contents.

In addition, there are high obstruction (occurs in small intestine) And low(the large intestine is obstructed).

Symptoms

The clinical manifestations of the disease are different:

Expressed – this is the constant and most early symptom. At first they are cramp-like in nature and recur every 10 minutes. The pain occurs suddenly, sometimes at night, and has no clear localization.

Repeated attacks of pain are associated with intestinal peristalsis, which is still trying to push through the contents. Then the muscles of the intestinal wall become depleted, the process enters the stage of decompensation, and the pain is constant. The pain subsides after 2-3 days, but this is a poor prognostic sign.

- Same early sign with low obstruction. With high obstruction at the beginning of the disease, stool may appear, sometimes even multiple times: the bowel located below the obstructed area is emptied.

With meconium ileus, there is no stool after the baby is born.

There may be bloody discharge in the stool, characteristic of intussusception. In these cases, it is necessary to differentiate obstruction from.

In case of partial obstruction, there may also be loose stool with an unpleasant putrid odor.

Gas retention, bloating. In this case, asymmetric bloating is characteristic: the intestine is swollen above the level of obstruction. Sometimes the swollen intestine is felt by the doctor when palpating the abdomen and is even visible to the eye.

Repeated vomiting is also characteristic of obstruction. Sometimes it is preceded by . The earlier vomiting appears, the higher the area of obstruction is. At first, vomiting is a reflex in nature due to a process in the intestines, and then it becomes a manifestation of intoxication of the body.

With pyloric stenosis, vomiting is first observed approximately 15 minutes after feeding the baby, and then the time interval between feeding and vomiting increases due to the expansion of the stomach. Moreover, the volume of vomit is greater than the volume of milk drunk (fountain vomiting). Dehydration and weight loss develop.

The child becomes restless, cries, has a pained facial expression, increased sweating, and pallor of the skin.

Diagnostics

X-ray examination helps the doctor make the correct diagnosis.

Interviewing the child (if possible by age) and parents: allows you to find out the time of onset of the disease, complaints, dynamics of the disease, individual characteristics the child's body.
The inspection provides an opportunity to evaluate general state child, identify abdominal pain and its location, bloating, the nature of vomit and stool (if any), tension in the abdominal muscles, the state of the cardiovascular and respiratory systems and etc.
By using X-ray examination can be carried out early diagnosis intussusception, confirm the presence of pyloric stenosis, lengthening sigmoid colon etc. According to the doctor's decision, in some cases air is pumped into the intestines through the rectum, and in some studies barium is used.
In cases that are difficult to diagnose, laparoscopy is used (for adhesive obstruction, torsion, etc.).
Ultrasound of the abdominal organs is used as an auxiliary examination method.

Treatment

If a child experiences abdominal pain, an urgent consultation with a surgeon is necessary! Attempts at self-medication are fraught with serious consequences due to lost time and late treatment.

At the slightest suspicion of intestinal obstruction, the child is hospitalized.

Treatment of obstruction can be conservative and surgical.

The choice of treatment method depends on the timing of seeking medical help and the form of obstruction. So, in case of congenital obstruction, with pyloric stenosis, with meconium ileus, surgical treatment .

Surgical treatment is also carried out for adhesive, the most severe and dangerous obstruction. In especially severe cases, it is sometimes necessary to remove the intestine to the anterior abdominal wall.

If you seek help late and necrosis (death) of the intestine develops, the affected area of the intestine is removed during surgery. In case of development of peritonitis, it is carried out complex treatment, including antibacterial drugs, detoxification therapy, painkillers and vitamins, and symptomatic treatment.

If you consult a doctor early about intussusception (no later than 12 hours from the onset of the first symptoms), conservative treatment . Using a special device, they pump air into the intestines and try to straighten the intussusception under the control of an X-ray machine.

To make sure that complete straightening of the intestine has occurred, the child remains under the supervision of a doctor in the hospital. Excess air from the intestines escapes through gas outlet pipe inserted into the rectum. A control X-ray examination is carried out using a barium suspension. If the intussusception is straightened, then after about 3 hours the barium enters the initial part of the large intestine, and is later excreted in the feces.

In newborns this is pathological condition intestines, in which the movement of masses through the large and small intestines is partially or completely disrupted.

Intestinal obstruction in infants may be difficult due to or the occurrence of some mechanical obstruction along the passage of the masses. This condition not only affects the child’s well-being, but can also become deadly.

There are the following types of intestinal obstruction:

congenital or acquired;
full or partial;
patency, which appears due to the formation of compression on parts of the intestine or when an object enters it from the outside;
dynamic.

1 Etiology of the disease

Newborns may experience congenital intestinal obstruction. This pathology is a violation of the intrauterine development of the child due to the incorrect size of the sigmoid colon or narrowing of the lumen at its border.

Often, the appearance of congenital intestinal obstruction results from a pathological narrowing of the lumen at the border of the stomach and intestines. This disease is called pyloric stenosis. Congenital intestinal obstruction causes delay and severe obstruction breast milk or formula in the first weeks of a newborn’s life. Thus, 2 weeks after the start of feeding, voluminous regurgitation of undigested milk is observed.

Also, the reason why congenital intestinal obstruction may occur is the atypical structure of the intestine in a newborn or a large number of"loops" on the large and small intestine.

There are many symptoms that accompany intestinal obstruction in newborns. The peculiarities of diagnosis are that in a newborn child it is impossible to accurately determine the symptoms that he feels. Parents should be alert to the following signs:

prolonged crying of the child, turning into a cry;
refusal of food;
constantly pulling the knees towards the stomach or “knocking” the legs;
absence of feces for several days;
heavy sweating of the baby in the absence of heat;
severe pallor, distortion of facial features, periodic lethargy.

The main symptoms of intestinal obstruction in newborns are as follows:

Severe paroxysmal pain. Pain is the first symptom of intestinal obstruction. They appear due to the fact that the intestines are trying to push through masses, but due to an obstacle they accumulate and begin to put pressure on the intestinal walls, thereby causing severe pain. The pain is not constant, but comes in attacks that last no more than 10 minutes. If the pain goes away completely, this is considered a bad symptom.
Retention of stool. Newborn babies can excrete feces from 1-2 to 5 or more times per day. Newly born babies pass meconium instead of stool. If this does not happen within a few hours after birth, it makes sense to talk about congenital intestinal obstruction. With partial obstruction, mucus and blood clots may be present in the stool, and the consistency of the stool can be very thick and even hard. In rare cases, diarrhea occurs with very unpleasant smell. This indicates the development of large colonies of bacteria in the intestines.
Bloating. It develops due to a large accumulation of gases and feces. If the patency is impaired, the child experiences asymmetry of the abdomen. It does not swell completely, but only in the part where the patency is impaired or completely absent.
Severe vomiting. Newborns who are not fed anything other than breast milk or formula may experience intestinal obstruction. severe vomiting. This is characterized by “fountain” regurgitation after a certain period of time after feeding.

3 Treatments

When diagnosing pathology in newborns, the doctor is deprived of one of the main ways to diagnose obstruction - an oral interview with the patient. There is no data on the location of pain and its intensity. Therefore, the primary anamnesis consists of interviewing parents based on their observations. Then the doctor conducts an additional examination of the child and palpation of the abdomen.

If intestinal obstruction is suspected, fluoroscopy and ultrasound are performed, as well as additional methods diagnostics

Treatment if intestinal obstruction occurs in a newborn is necessary immediately. With prolonged development of the pathology, the child’s condition becomes fatal.

On early diagnosing obstruction, depending on its causes, treatment can be conservative. It is possible to avoid surgery if you go to the hospital at the first symptoms. When intussusception or volvulus occurs, air is forced into its cavity. Under its pressure, the intestine gradually begins to straighten. Additionally, drugs are introduced into the child’s body that improve digestion and have a positive effect on intestinal motility. To diagnose complete straightening of the intestine, barium is injected into the gastrointestinal tract. With a healthy intestine, it goes through the entire cycle in a few hours.

If more than 12 hours have passed since the onset of pain and bloating, the child needs emergency surgery. With later treatment, the incidence of necrosis (due to necrosis of part of the intestine) or peritonitis (rupture of the organ under the pressure of feces) is high.

In case of intussusception and volvulus, the doctor performs an operation and manually straightens the twisted sections of the large or small intestine.

In this case, there are often areas of the intestine where necrosis has begun. When such a pathology develops, part of the intestine is removed.

The formation of adhesions in an organ is a fatal condition for a child. Therefore, the operation is performed on an emergency basis. The doctor removes the intestines into the anterior abdominal cavity and removes adhesions.

After the operation, the child is given painkillers, anti-inflammatory and restorative drugs.

Intestinal obstruction (volvulus) occurs in people at any age, but for children this disease is especially dangerous. The child’s body is not yet sufficiently developed, so problems with gastrointestinal tract may cause serious complications. Intestinal obstruction in children causes pain symptoms in the tummy, nausea and profuse vomiting.

Intestinal obstruction (intussusception) in children is a serious condition in which part of the intestine penetrates (slips, wraps up) into the adjacent part of the intestine, as a result of which the movement of feces through the intestine completely or partially stops. For this reason, the disease is sometimes called “volvulus.” Volvulus in children often blocks the movement of stool and also cuts off blood flow to part of the intestine, which can lead to a tear in the intestine (perforation), infection, and death of intestinal tissue. In severe cases, surgery is required to eliminate the disease.

The complexity of the development and course of the disease depends on in which part of the intestine the obstruction occurs. The disease is most acute if the blockage occurs in the upper part of the intestine.

The disease develops rapidly: the first signs appear within short term and are developing very quickly.

Types of disease

Blockage of certain parts of the intestine can occur in children of any age, including infants and newborns.

Main types of intestinal obstruction:

Congenital. This type of disease occurs due to pathologies during the development of the child’s gastrointestinal system. In some cases on early stage intrauterine development, congenital intestinal obstruction develops in the fetus even before birth. As a result, the baby is born with this disease. The course of the disease depends on the degree and level of obstruction. At high level blockage, the newborn vomits bile. A low degree of obstruction is characterized by the presence of stool retention and gag reflexes in the child, which occur a few days after birth.
Acquired. There are various forms of acquired disease. The most common type of disease is mechanical obstruction (intussusception). Less commonly, intestinal obstruction occurs due to the presence of adhesions. The disease is observed in small children from birth to 1 year. This type of intestinal blockage occurs suddenly and is characterized by sharp pains, vomiting. Baby's stool may contain bleeding and mucus.

Causes of the disease

In the vast majority of cases, the cause of intussusception in children is unknown. Since intussusception occurs more often in the autumn-winter period and in many children intussusception occurs during acute respiratory viral infections, a number of scientists associate intestinal obstruction with the effects of viruses that cause these acute respiratory viral infections.

Risk factors for intussusception include:

Age. Children—especially young children—are much more likely to develop intussusception than adults. Intestinal obstruction is most often diagnosed in children aged 6 months to 3 years.
Floor. Invasion most often affects boys.
Abnormal formation of the intestinal tract. Intestinal malrotation is a condition in which the intestines do not develop or fold correctly, and this increases the risk of intussusception.
History of intussusception. If a child has already had intussusception once, he or she is at increased risk of developing the condition again. Invasion recurs in more than 10% of patients.
Family history. If there is a history of intussusception in the family, the child has an increased risk of this disease.

Signs and diagnosis of the disease in children

How to determine that a child has a volvulus? There are several signs. The most important one is:

Cramping pain. The first sign of an intestinal obstruction in a baby may be sudden, loud crying caused by abdominal pain. Babies under one year old with abdominal pain may pull their knees toward their chest when they cry. The pain comes and goes, usually every 15 to 20 minutes. Over time, these painful episodes last longer and occur more frequently;

Other common signs and symptoms of intestinal obstruction include:

Lack of appetite, refusal to eat;
Bloating (flatulence);
Nausea and vomiting;
Retention of stool;
Lump in the abdominal cavity;
Difficulty or absent stool;
In some cases, diarrhea is possible;
Temperature increase;
Presence in stool bloody discharge and mucus, visually similar to “currant jelly”;
Lethargy.

Not all children have all of these symptoms. Some children do not have blood in their stool or a lump in their abdomen. Some older children have no symptoms other than pain.

Invasion requires emergency medical care. If your child develops the signs or symptoms listed above, get medical help right away.

Remember that in young children (up to one year old), signs of abdominal pain may include periodic drawing of the knees to the chest and crying.

Important! If the child has sharp pains in the abdomen, you should urgently seek medical help. Intestinal obstruction in the vast majority of cases is accompanied by abdominal pain of varying intensity.

If a child experiences the above symptoms, parents should immediately contact a surgeon or pediatrician. The doctor will conduct diagnostics, make a diagnosis and prescribe treatment that will correspond to the child’s age and the severity of the disease.

These symptoms are similar to other diseases such as appendicitis.

Possible complications

An intestinal obstruction can cut off blood flow to the affected part of the intestine. If this condition is left untreated, the lack of blood causes tissue in the intestinal wall to die, and it can also lead to a tear (perforation) in the intestinal wall, which can cause an infection in the abdomen (peritonitis).

Diagnosis of the disease

Be prepared to provide full information to your doctor on the following questions:

When did your child start experiencing stomach pain or other symptoms?
Is the pain continuous or intermittent?
Does the pain start and end suddenly?
Has your child experienced nausea, vomiting, or?
Have you noticed your child?
Have you noticed any swelling or swelling in your baby's abdomen?

To confirm the diagnosis, the doctor may prescribe:

Ultrasound or other diagnostic procedure visualization of abdominal organs. Ultrasound, X-ray or CT scan(CT) may reveal intestinal obstruction. The results of the obtained images, as a rule, show a “bull’s-eye”, which is the intestine rolled up in intussusception. Abdominal imaging can also show if the intestine has been ruptured (perforated).
Air or barium enema. An air or barium enema enhances visualization of the colon. During the procedure, the doctor will insert air or liquid barium into the colon through the rectum. In addition, an air or barium enema can in many cases correct the intussusception itself, in which case additional treatment not required. A barium enema cannot be used if there is an intestinal rupture (perforation).

Treatment of illness in a baby

If you notice signs of intestinal obstruction in a child, do not give him food or medicine until he has been examined by a doctor.

Important! If a child develops symptoms of intestinal obstruction, urgent hospitalization is necessary. Self-medication can lead to complications and serious consequences.

Urgent health care required to avoid dehydration and severe shock, and to prevent infection that can occur when part of the intestine dies due to lack of blood.

The baby is examined for the presence of intestinal disease by a surgeon. If complications occur, surgical intervention is necessary.

To treat intestinal obstruction, your doctor may prescribe:

Air enema or barium enema. It is both a diagnostic procedure and a treatment. If the enema works, further treatment is usually not required. This procedure is very effective in children.
Surgery. If the intestines rupture or enemas fail to straighten the intestines, surgery is necessary. The surgeon will release the part of the intestine that has become twisted, remove the blockage (obstruction), and, if necessary, remove dead intestinal tissue.

If the intestinal disease is not in an acute, advanced stage, conservative therapy is prescribed. It consists of a set of procedures to remove stagnant feces from the intestines and cleanse the body of harmful substances and toxins.

The following procedures may also be prescribed to your baby:

To stop the vomiting process, the stomach is lavaged through a special tube;
Medicines are administered intravenously that help restore water-salt balance;
Antiemetic, analgesic and antispasmodic medications;
At successful treatment The baby may be prescribed the medicine proserin, which stimulates proper intestinal activity.

Prevention of recurrence of the disease

After eliminating the causes and symptoms of intestinal obstruction, the child should follow a diet for some time. The child's diet should contain only those foods that have a positive effect on the intestinal microflora.

The diet is aimed at eliminating putrefactive processes and fermentation in the gastrointestinal tract.

Basic rules for feeding a baby after an illness.

Should be excluded food products, contributing to the formation of gases;
The daily menu should consist of low-fat broths, steamed meat, pureed dishes;
The child should not be given sweets, starchy foods, as well as salty and fried foods;
The baby should be given rosehip decoction and green tea at least twice a day;
In summer, it is recommended to include fruit jelly, compotes and fruit drinks in a child’s diet;
The child should consume fermented milk products daily.

If the diet is not followed, every second child ends up in the hospital again with a relapse of the disease.

Intestinal obstruction in young children can occur in different forms. It is very important to consult a specialist in time and begin treatment to avoid complications.

Be healthy!