Intestinal obstruction (Children)

👶 Intussusception is the most common cause of intestinal obstruction in children under 2 years of age. It is a true paediatric emergency – prompt recognition and treatment can be life-saving.

📖 About

• Leading cause of bowel obstruction in infants and toddlers.
• Occurs when one segment of intestine telescopes into another → impaired venous return → bowel ischaemia.
• Requires urgent recognition and management.

⚠️ Aetiology

• Can be idiopathic (most common in infants).
• Pathological lead points: Meckel’s diverticulum, intestinal polyps, lymphoma.
• Viral infection causing Peyer’s patch hypertrophy is a common trigger.

🩺 Clinical Features

• Intermittent, severe, colicky abdominal pain (drawing knees to chest).
• Bilious vomiting 🤢.
• “Currant jelly” stool (blood + mucus) – late, classic sign.
• Abdominal mass (often sausage-shaped, right upper quadrant).
• Absolute constipation and abdominal distension with high-pitched or absent bowel sounds.

🔍 Causes of Intestinal Obstruction in Children

• 🍼 Congenital anomalies
  • Features: Vomiting, distension, feeding intolerance, no meconium.
  • Diagnosis: AXR, ultrasound, contrast studies.
  • Management: Surgical correction depending on anomaly.
• 🎯 Intussusception
  • Features: Colicky abdominal pain, “currant jelly” stool, palpable sausage-shaped mass.
  • Diagnosis: Ultrasound → “target/doughnut sign.”
  • Management: Air/contrast enema (diagnostic + therapeutic); surgery if reduction fails.
• 🪢 Hernia
  • Features: Painful groin/umbilical lump, vomiting, bowel obstruction.
  • Diagnosis: Clinical ± ultrasound.
  • Management: Manual reduction if possible; surgical repair.
• ✂️ Adhesions
  • Features: Colicky pain, distension, vomiting, past surgical history.
  • Diagnosis: AXR, CT abdomen.
  • Management: Conservative (NG tube, fluids); surgery if strangulated.
• ⚡ Malrotation + volvulus
  • Features: Bilious vomiting, abdominal distension, shock 🚨.
  • Diagnosis: AXR, Upper GI contrast series.
  • Management: Emergency surgery (Ladd’s procedure).

⏸️ Causes of Ileus in Children (Functional Obstruction)

• 🔪 Postoperative ileus
  • Features: Bloating, ↓ bowel sounds, nausea/vomiting.
  • Diagnosis: AXR, exclude mechanical obstruction.
  • Management: Supportive → bowel rest, IV fluids.
• ⚕️ Functional ileus (systemic illness)
  • Features: Abdominal distension, nausea, association with systemic illness.
  • Diagnosis: Clinical + supportive imaging.
  • Management: Supportive, treat underlying cause.
• 🦠 Infectious
  • Features: Fever, abdominal pain, diarrhoea/constipation.
  • Diagnosis: Stool tests ± imaging.
  • Management: Targeted antibiotics/antivirals.
• ⚡ Electrolyte imbalance
  • Features: Distension, nausea, confusion.
  • Diagnosis: U&E (electrolytes).
  • Management: Correct imbalance + supportive care.
• 💊 Medications
  • Features: Constipation or diarrhoea depending on drug, relevant medication history.
  • Diagnosis: Medication review.
  • Management: Stop culprit drug, supportive care.

🔬 Investigations

• Bloods: FBC, U&E, CRP.
• AXR: Dilated loops, air-fluid levels, absence of rectal gas.
• Ultrasound: Best for intussusception – 🎯 target or doughnut sign.

🧠 Pathology

• Mechanical: e.g. intussusception, malrotation, hernia, adhesions.
• Functional: e.g. ileus (post-op, infection, metabolic, drug-induced).

💊 Management Principles

• 🚑 Resuscitation: NBM, NG decompression, IV fluids, correct electrolytes.
• 📞 Early surgical referral is vital.
• Intussusception: Air contrast enema (first line, therapeutic in most); surgery if unsuccessful or perforation suspected.
• Close monitoring for peritonitis, sepsis, shock.

📚 References

• UpToDate – Intussusception in Children
• NCBI – Intestinal Obstruction in Children