Intestinal Obstruction In Children

Intestinal obstruction is interruption of normal passage of intestinal contents from mechanical blockage or severe functional ileus. Causes vary strongly by age: malrotation with volvulus, intussusception, incarcerated hernia and congenital abnormalities dominate early childhood, while adhesions become important after previous abdominal surgery.

A strangulated obstruction compromises blood supply and can progress rapidly to bowel necrosis and perforation.

• Colicky abdominal pain
• Vomiting
• Abdominal distension
• Failure to pass stool or flatus
• Altered bowel sounds

Bilious green vomiting is intestinal obstruction until proven otherwise, particularly in an infant.

Strangulation is suggested by:

• Continuous severe pain
• Peritonism
• Fever
• Tachycardia
• Shock
• Bloody stool
• Metabolic acidosis

• Abdominal radiography may show dilated bowel loops and air fluid levels.

• Ultrasound is useful for intussusception, volvulus and other paediatric causes.

• Upper gastrointestinal contrast imaging is particularly important when malrotation is suspected in a stable infant.

• Check FBC, electrolytes, renal function, glucose, lactate and blood gas in significant obstruction.

• Immediate surgical assessment.

• Keep nil by mouth.

• Insert IV access and correct volume and electrolyte deficits with isotonic crystalloid.

• Nasogastric decompression is indicated for significant vomiting or distension.

• Give antibiotics if strangulation, perforation or peritonitis is suspected.

• Bilious vomiting with suspected midgut volvulus requires emergency surgery. Do not delay definitive treatment for prolonged investigations in a deteriorating child.