Intestinal obstruction in newborns: causes, symptoms, treatment methods

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Intestinal obstruction in newborns is an unpleasant pathology in which there is a complete or partial blockage of the large or small intestine. It makes it difficult for liquids, food and gas to pass through the standard path, bypassing the intestines. Often the blockage provokes severe pain that comes and goes. Obstruction occurs in one child out of one and a half thousand. At the same time, this ailment is so serious that it is worth suspecting in any child, without exception, if he constantly vomits, there are pains in the abdomen, a characteristic bloating. Delayed treatment can lead to fatal consequences.

Features of the disease

Intestinal obstruction in newborns, if not controlled and treated, can lead to vascular damage in the intestines. Because of this, its tissues die, blood supply decreases, walls collapse, which inAs a result, it leads to infection of the whole organism. In some cases, this is fatal.

Intestinal obstruction in newborns can be caused by various pathological processes. At the same time, acquired and congenital obstruction is distinguished.

Congenital intestinal obstruction in newborns is provoked by failures during the development of the baby in the womb. This can be caused by: a violation of the rotation of the intestine during the formation of the gastrointestinal tract, malformations of the intestine, pathology of other organs located in the abdominal cavity.

Acquired obstruction becomes a consequence of an operation or an inflammatory process in the body.

Types of obstruction

Doctors distinguish several types of intestinal obstruction, depending on certain criteria. What matters is the absence or presence of a specific physical obstacle. In this case, mechanical and dynamic obstruction are separated. With mechanical blockage of the intestine with scar tissue, a tumor, or other block that prevents the contents of the intestine from penetrating through the blockage point. With dynamic obstruction, muscle contractions stop completely or are partially disturbed.

According to the level of the affected area of the intestine, low and high obstruction is distinguished. If the first becomes a consequence of stenosis of the small intestine or atresia, then the second occurs due to stenosis of the duodenum 12.

According to the degree of patency, there is partial intestinal obstruction in a newborn, whena small amount of stool still passes, and full, when there is no stool at all.

According to the rate of development of symptoms, chronic and acute obstruction is distinguished. Chronic symptoms develop slowly, while acute symptoms develop as rapidly as possible.

Reasons

If the main causes of intestinal obstruction in newborns are hernia, volvulus, intussusception and adhesions, then the problem should be sought in the small intestine.

Obstruction in the thick appears due to tumors, volvulus, diverticula. Often this disease appears in very young babies. Intestinal obstruction in children under one year old occurs due to volvulus, intussusception and hernia. At the same time, diagnosing the disease is especially difficult, since babies cannot yet formulate what specifically worries them.

Now we will tell you more about these or those reasons. Intestinal obstruction in newborns provokes Hirschsprung's disease. It is a motor disorder that affects up to 25% of infants with characteristic intestinal obstruction. In some cases, symptoms do not appear until late infancy or later in life.

Such patients do not have ganglia in their bodies - special nerve cells in the walls of the large intestine. This affects the wave-like movements that promote the movement of food. The first sign of this disease in most babies is the absence of a stool with meconium for 48 hours after birth. Other signs appear later. For example, stretchedstomach, chronic constipation, lack of appetite, developmental delay, vomiting. The solution to this problem is usually surgical removal of part of the large intestine.

Ideally, surgery should be done before 6 months of age. This ailment is directly related to some other congenital conditions, including Down syndrome.

Meconium ileus is associated with the original feces, which is called meconium. It is fibrous and atypically dense, making it hard to come out. Ideally, such feces should consist of bile and mucus. Unhe althy meconium blocks the intestines. It has to be eliminated with the help of an operative surgical intervention or an enema.

This condition occurs due to a lack of digestive enzymes produced in the pancreas, such as trypsin. This problem causes the infant to develop cystic fibrosis.

Intestinal obstruction in a newborn baby appears due to volvulus. This condition often occurs in young children when the colon or small intestine rolls on its own.

When the duodenum is twisted, a duodenal closure is formed. In this state, the section of intestine that connects the small intestine and stomach twists. As a result, the blood flow in the intestinal loop is disturbed (in fact, the so-called suffocation begins), the reduction in oxygen supply to the tissues provokes gangrene. Intestinal tissue simply dies. In a quarter of cases, strangulation is possible. This is a dangerous disease that can progress to gangrene within 12hours.

Another dangerous cause of obstruction is intussusception. At the same time, the intestines, as it were, fold into themselves, as happens with a household radio antenna. This condition is typical for babies from three months to 6 years of age.

Hernias can also block part of the intestine. In this case, they tightly block the passage of food.

Post-surgical and congenital adhesions are another cause of obstruction in children. Adhesions look like strips of fibrous tissue that connect with the abdominal organs, each other, and intestinal loops. Because of this, the distance between the walls of this organ is significantly limited, the passage of food becomes impossible.

While adult patients tend to develop adhesions most often after surgery, children may develop adhesions after abdominal surgery.

Symptoms

Diagnosing this disease is often difficult, as the symptoms of bowel obstruction in newborns vary. Ultimately, it all depends on the type of blockage and location.

There are several telltale signs that help you identify where the problem is. If vomiting appears almost immediately, and then the baby overcomes constipation, then the affected area should be looked for in the small intestine. If the small intestine is blocked, the symptoms of bowel obstruction in a child develop faster, but the symptoms in the large intestine appear gradually, they are usually milder.

The main difficulties arise withdiagnosing one or another type of obstruction in infants, since they cannot tell what worries them. Therefore, their mothers and fathers should be especially attentive, monitor changes in the child, which may indicate a problem.

One of the earliest signs of bowel obstruction in children is undulating spasms and pain in the abdomen. They reappear and then disappear. At the same time, the baby tucks his legs under him and even cries, it hurts so much. Between attacks, he can behave calmly for up to 30 minutes. After the pain and tears come back again. Such discomfort appears due to the inability of the intestinal muscles to move already digested food through the obstacle that has appeared.

Another classic symptom of bowel obstruction in newborns is blood in the stool that appears immediately after a bout of crying. Vomiting is typical for this condition. When it appears, it helps to understand the location of the problem. If the baby begins to feel sick immediately after an attack of pain, then the problem is in the small intestine, and if after a while, then in the large intestine. A characteristic sign of intestinal obstruction in a newborn is green vomit.

When an absolute intestinal blockage occurs, the baby is unable to pass feces and gas. However, if the obstruction is partial, he may develop diarrhea. Fever is not characteristic of this disease.

Complications

It is important to treat this disease in a timely and effective manner, otherwise you will not avoid dangerous complications. If the contents of the intestinestops passing through obstacles, the body begins to consume too large volumes of fluid from the intestinal lumen. Because of this, the skin in the abdomen becomes stretched and shiny, pain occurs on palpation. Due to constant vomiting, the body becomes dehydrated.

Imbalance of fluid provokes an imbalance of important chemical elements that are contained in the blood. These are electrolytes. Because of this, complications associated with irregular heartbeats appear. If the electrolyte balance cannot be promptly restored, there will be a shock.

Another dangerous complication is kidney failure. It appears as a result of systemic intoxication due to a violation of the integrity of the intestine or dehydration. Therefore, it is important to identify the pathology at an early stage in order to carry out effective treatment.

Diagnosis

In childhood, it is extremely difficult to make a diagnosis of intestinal obstruction, as the child often cannot clearly formulate his complaints. Therefore, a whole range of examinations and various tests are being carried out.

The basis, of course, is a visual examination of the patient. The doctor begins to suspect the presence of this problem, if a lump can be felt in the abdomen, it becomes too sensitive to palpation, outwardly swollen. Bowel sounds can be heard with a stethoscope.

An abdominal x-ray is recommended to confirm the diagnosis. However, this is a rather inaccurate method, in which some obstacles can simply be overlooked. And here is the computertomography allows you to get a cross-sectional image taken from several different angles.

In childhood, ultrasound is considered the preferred method. In this case, the child will be harmed the least.

In some cases, the doctor may inject air or liquid barium into the large intestine through the rectum. This would be called a barium or air enema. If your baby has intussusception this may help fix the problem and no further treatment is needed.

Treatment methods

Patients suspected of having this pathological condition must be hospitalized. Treatment of intestinal obstruction in children should begin immediately to prevent pinching of intestinal loops. This could be fatal.

There are a lot of methods of dealing with this disease. At the same time, one of the first is almost always the introduction of a nasogastric tube, through which all contents are removed from the intestines and stomach. The patient is then given intravenous fluids to correct the electrolyte imbalance and stop dehydration.

In some cases, it is possible to avoid surgery for intestinal obstruction in a newborn. For example, in the case of volvulus, a rectal tube inserted into the intestine helps. More than half of newborns benefit from a barium enema.

Gastrograph is also used. It is a contrast agent that not only has a powerful therapeutic effect, but can also improve the quality of bowel scanning.

Sometimes againstpartial obstruction is helped by an air enema. It is worth noting that after any of these procedures, the baby is left in hospital for a few more days to observe his condition.

Operation

Sad as it may seem, but in most cases, surgery is required for intestinal obstruction in a newborn. If other methods failed to correct the situation, it is inevitable.

As a rule, complete obstruction requires surgical intervention. With partial, in most cases it is possible to cope without it. An emergency operation is prescribed if there are strangulated bowel sites. Part of the intestine is cut out, the affected area is completely removed.

When a tumor, scar tissue or polyps is the cause of an obstruction, they also require urgent removal. Hernias are repaired to restore intestinal patency.

In parallel, drug treatment with antibiotics is used. They are prescribed both before and after surgery. This eliminates the possibility of infection at the site of obstruction. In parallel, intravenously, the body is replenished with fluid, if necessary.

Allows you to avoid many of the dangerous consequences of surgery for intestinal obstruction in newborns. Immediate intervention by an experienced surgeon is often the only chance to correct an obstruction.

As an alternative therapy, a special diet with a significant content of fibers is advised, which helps to stimulate the rightstool formation.

Forecast

According to the reviews of patients who themselves have encountered such a problem, in the overwhelming majority of cases, obstruction can be overcome with the help of timely qualified medical care. Then there is a great chance that the child will recover without consequences for the body. If you do not pay attention to obstruction, it can be very dangerous, even fatal.

One of the consequences of this condition is the infection of the whole organism. In this case, the intestine loses its integrity or is pinched. There are many tactics for medical treatment of volvulus, but in this case, the probability of recurrence reaches 80%.

Prevention

The good news for parents of babies is that most often obstruction can be prevented by initially preventing the appearance of this pathological condition. Timely surgical removal of polyps and tumors in the intestine helps to avoid relapses. In this case, adhesions can form after the operation, turning into another cause of obstruction.

To prevent some types of problems associated with obstruction, you should follow a proper diet. Eat enough fiber, as this is what contributes to the formation of normal stools and the constant emptying of the intestine.

Diet food must include fresh and dried fruits, especially apples, prunes, lentils, beans, seeds, nuts, raw vegetables, foods withlots of coarse fibre. The latter include cereals and whole grain breads.

In a baby, the definition of intestinal obstruction directly depends on various related symptoms. Be sure to remember that a he althy diet, as well as plenty of water to drink throughout the day, will keep your intestines he althy.

Parents are obliged to monitor the work of their child's body. Inform the pediatrician of all anomalies. In this way, many he alth problems for children can be avoided.