Intestinal obstruction

Question 1

What is intestinal obstruction?

Answer 1

Where a physical obstruction prevents the flow of faeces through the intestines, leading to back pressure through the GI system, causing vomiting and absolute constipation.

Question 2

What are the causes of intestinal obstruction?

Answer 2

Meconium ileus, Hirschsprung’s disease, oesophageal atresia, duodenal atresia, intussusception, imperforate anus, malrotation of the intestines with a volvulus, strangulated hernia.

Question 3

What are the presentations of intestinal obstruction?

Answer 3

• persistent vomiting, which may be bilious, containing bright green bile
• abdominal pain and distension
• failure to pass stool or wind (absolute constipation)
• shock (hypotension, tachycardia, pallor)
• dehydration

Question 4

What are the signs on examination for intestinal obstruction?

Answer 4

• tympanic sound (hollow/drum like) on percussion (due to air filled loops of bowel)
• abnormal bowel sounds: can be high pitched and ‘tinkling’ early in the obstruction and absent later

Question 5

How is intestinal obstruction diagnosed?

Answer 5

Abdominal x-ray may show dilated loops of bowel proximal to the obstruction and collapsed loops of bowel distal to the obstruction, with absence of air in the rectum.

Question 6

What is the management for intestinal obstruction?

Answer 6

Refer to paediatric surgical unit as emergency, NBM, insert NGT to help drain stomach and stop vomiting, IV fluid to correct dehydration and electrolyte imbalances, definitive management depends on the cause.