ABSTRACT

HOW TO DIAGNOSE NEONATAL INTESTINAL OBSTRUCTION

Tubagus Odih R Wahid
Medicine Of Faculty Riau University
Arifin Ahmad General Hospital Pekanbaru Riau Indonesia

Intestinal obstruction (IO) is shortly defined as the bowel movement failure, which can be
classified as mechanic (in example, any kind of digestive tract atresia) or functional (i.e.
Hirschsprung disease, meconium ileus or necrotising enterocolitis) . During the first period of
life, mechanic IO is the most frequent type of IO, accounting 1 in 2700 live births , and it is
usually due to some congenital anatomic anomaly . Also, IO represents one of the main reasons
for neonatal surgery performance and Neonatal Intensive Care Unit (NICU) admittance
The clinical presentation of IO often consists in the following signs: 1. Vomiting happens
more frequently when the obstruction is located above Treiz’s angle. Its content will be bilious
unless the obstruction occurs before the second portion of the duodenum (i.e. pyloric
hypertrophy or, rarely, pyloric atresia) 2. Abdominal distension, as a result of gas (swallowed,
bacteria fermentation) and liquid (swallowed, gastric and biliopancreatic secretions)
accumulation proximal to the obstruction level. This will lead to intestinal edema, dehydration
and, in the most severe cases, perforation and sepsis . When this sign is not appearing, the
possibility of a fistula may be considered. 3. Failure to pass meconium is not always present,
since: 1) if the IO is settled beyond the first 48 hours of life, meconium could already have been
expelled; 2) if the IO is not complete, some quantity of meconium can still be expelled; and 3) if
there is any fistula, meconium could have been expelled through the urethra or vagina . Other
signs and symptoms, such as hypoactivity, fever, hypovolemia or leukocytosis, involve severity
and worsen the prognosis .
During pregnancy, even though 30% of the cases of polyhydramnios represent a sign of
congenital malformation , most of the times the diagnosis is postnatal due to the absence of
intrauterine manifestations. For so, physical examination in vital, moreover, imaging procedures
have not strongly demonstrated their usefulness in any of the diseases mentioned above . In spite
of the low quality of the evidence supporting imaging for diagnosing specific neonatal IO, it can
give some guidance for the accuracy of the management. The most recommended performances
are upper gastrointestinal contrast study for malformation and volvulus , contrast enema for
Hirschsprung disease and cross-table lateral radiographs for imperforate anus . The use of
imaging for intestinal atresia has the most limited evidence, although upper gastrointestinal
contrast study is usually performed .