Intestinal Obstruction

in Pediatric Patients
Dr. Sugianto Prajitno, Sp.BA
 Introduction
Pediatric intestinal obstruction often
result in life threatening and mandates
immediate surgical intervention

The diagnostic of intestinal obstruction

in pediatric patients is challenging

Delay in diagnosis might cause

physiological alterations and usually
fatal
 Pathophysiology
Venous
obstruction

Dilatation Edema of
Accumulating
proximal to bowel segment
secretions
obstruction
Arterial
blockage

Ischaemic
necrosis

Blockage of
intestine Bacterial
translocation Perforation

Septicaemia Peritonitis
 Intestinal Obstruction
Classification
Age:
Onset:
Newborn
Acute intestinal obstruction
Infant to 24 months
Chronic partial intestinal obstruction
24 months or older

Intestinal obstruction

Level of obstruction:
Duodenal
Congenital
Jejunal
Acquired
Ileal/colonic
Anus
 Acute Intestinal Obstruction
Sign & symptoms

Abdominal
Bilious emesis No passing gas Colicky Pain
distention

 Pediatric bilious emesis is a surgical emergency until proven otherwise

 A child with intestinal obstruction can still have bowel movements, but they
won’t pass gas
 Acute Intestinal Obstruction
Plain Abdominal X-Ray

High intestinal Low intestinal

Non-specific
obstruction obstruction

Double bubble Many gas filled

(Duodenal loops of
Atresia) intestinal (Ileal May show bowel
atresia, obstruction,
meconium ileus, double bubble or
Few gas filled meconium plug gasless
loops beyond syndrome, (Malrotation)
duodenum Hirschsprung
(Jejunal Atresia) disease)
Acute Intestinal Obstruction

Upper G.I. Series

Bird’s beak  Malrotation

Doule buble, distal air 

Stenosis duodenum

String sign  Pyloric stenosis

 Acute Intestinal Obstruction
Contrast Enema
Contrast enema differentiate the various types of low
intestinal obstruction

Microcolon  jejuno-ileal atresia

Soap bubble appearance  Meconium ileus
Transitional zone  Hirschsprungs disease
Cupping, coiled spring  intussusception

High position of caecum  malrotation

Acute Intestinal Obstruction
Ultrasonography and Doppler USG

Target sign  Intussusception

Inversion of the superior mesenteric vessel

orientation  Malrotation

Whirlpool sign  Midgut volvulus

 Diagnosis

 Diagnosis of pediatric intestinal obstruction is

made base on:

Accurate Laboratory
Clear history
physical and imaging
taking
examination evaluation
 Duodenal Atresia
Scaphoid abdomen

Double bubble appearance

 Jejuno-ileal Atresia
Microcolon

Bowel contour

Jejunal atresia
Hirschsprung’s disease
 Hirschsprung’s disease

Transitional zone in colon

Transitional zone
Malrotation and Midgut Volvulus
Malrotation and Midgut Volvulus
Malrotation and Midgut Volvulus
 Malrotation and Midgut Volvulus
Contrast enema

Upper GI series
 Malrotation and Midgut Volvulus
Inversion of the superior
mesenteric vessel orientation
is shown by Ultrasonography

Doppler USG
The “Whirlpool” Sign
Meconium Ileus
Intestinal Adhesion
 Intussuseption

Intussusception

Sausage like mass Currant jelly stool

 Intussusception
Target’s sign

Intussusception

Cupping
 Conclusion

 Every pediatric patients with intestinal

obstruction should be considered as a surgical
emergency until proven otherwise

 Management of pediatric intestinal obstruction:

The earlier the diagnosis,
the better the result
Thank You