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INTESTINAL OBSTRUCTION
By:
Brig Mushahid Aslam
“Neither sun shall rise nor set on patient of intestinal obstruction”
Sequence
 Duodenal Atresia
 Jejuno-ileal Atresia
 Meconium Ileus
Definitions
 Agenesis
 Aplasia
 Atresia
 Hypoplasia
 Hyperplasia
 Dysplasia
absence of organ or primordium
absence of organ due to failure of
primordium
absence of an opening
incomplete development of an
organ
overdevelopment of an organ
abnormal cell organization
Duodenal Atresia
 1: 5000
 Associated Anomalies




Down’s Syndrome 30 %
Congenital Heart Diseases
Malrotation
Anorectal Malformations
Congenital Atresia
of the Small Intestine
“Vascular Accidents”
blood supply to a region of the bowel is
compromised and a segment “dies”,
resulting in narrowing or
complete loss of that region
50%
20%
20%
a
region
of the bowel
is lost
a
fibrous cord
remains
narrowing, with
a thin diaphragm
separating the larger
and smaller pieces of
bowel
N.B. stenoses (5%) and multiple atresias (5%) account for the remaining defects
Presentation
 Antenatal
 USG
 Polyhydramnios
 Distended stomach and 1st part Duodenum
 Newborn




Feeding Intolerance
Bilious Vomiting
Scaphoid Abdomen
Failure to pass Meconium
Association
Types
Type I：
Complete
membrane
obstructing the
lumen
Type II：
A pouch with a
fibrous cord
connecting to
the distal
duodenum
Type III：
blind-ending
pouch with no
connection to
the distal
duodenum
Investigations
Management





NPO
Nasogastric aspiration
Intravenous fluids
Antibiotics
Surgery
5’ Hs





Hypothermia
Hypoxia
Hypovolemia
Hypoglycaemia
Hypoprothrombinaemia
Management
Management
Jejuno-ileal Atresia
 1/2000
 Vomiting
 Abdominal Distension
 Failure to pass meconium
Pathogenesis
 Mesenteric vascular accidents
during early embryologic
development  infarction 
organization + resorption of the
necrotic segment
 The bowel segment distal to the
atresia may contain meconium,
indicating previous continuity of
the intestine
Types
Types
Types
“APPLE PEEL” ATRESIA
CONGENITAL MIDGUT ATRESIA
Investigations
Management
Management
Meconium Ieus
 30 % intestinal obstruction
 Associated Anomalies
 Cystic Fibrosis 15%
 Atresia
 Malrotation
Presentation
 Newborn




Feeding Intolerance
Bilious Vomiting
Abdominal Distention
Failure to pass Meconium
Investigations
Treatment
 Hypertonic Enema Washouts
 Gastrograffin 25-50 %
 Effective 30-60 % cases
 N-Acetyl cysteine 10 %
Management