Bowel Obstruction

Question 1

DDx for intestinal obstruction without bilious vomiting

Answer 1

• duodenal atresia (if obstruction proximal to Ampulla of Vater 20 per cent of cases)
• duodenal stenosis
• annular pancreas
• pyloric stenosis

Question 2

DDx for intestinal obstruction with bilious vomiting

Answer 2

• malrotation and volvulus
• duodenal atresia
• jejunoileal atresia
• meconium ileus
• meconium plug syndrome (18 per cent)
• Hirschsprung’s disease (8 per cent)

Question 3

meconium plug syndrome vs meconium ileus

Answer 3

• Cf meconium ileus: plug has normal meconium, ileus has thick meconium

Question 4

Meconium ileus: typical image on AXR

Answer 4

Ground glass appearance on AXR: mix of meconium with swallowed air

Question 5

Hirschprung’s disease:

• When does it usually present?
• Syndrome association
• Some clinical features
• Complications
• Definitive Dx by?

Answer 5

• First 6 weeks usually, M>F
• Associated with T21
• Features: failure to pass meconium, abdo distention, vomiting
• Complications:
  
  • Enterocolitis (avoid enema -> perforation)
  • Distal short segment disease later in life
• Definitive Dx: suction rectal biopsy with AChAse staining: absence of ganglion cells

Question 6

DDx for intestinal obstruction with marked abdominal distension

Answer 6

• ileal atresia
• Hirschsprung’s disease
• meconium ileus
• meconium plug syndrome
• imperforate anus.