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Intestinal obstruction (Children)

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Anaesthetics and Critical Care

Obstetrics Gynaecology

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Urology

Version Jan 2023

Intussusception is the most common cause of bowel obstruction in patients aged less than 2 years.

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Cause of intestinal obstruction

Aetiology

Multiple

Clinical

Vomiting often bilious
Abdominal pain
Absolute constipation (no faeces, no flatus)
Abdominal distension
High pitched or absent bowel sounds

Causes

Hirschprung's disease
Intussusception
Meconium ileus
Oesophageal atresia
Duodenal atresia
Malrotation of intestines
Imperformate anus
Strangulated hernia
Congenital abdominal bands

Type	Small Bowel	Large Bowel
Abdominal Pain	Early and colicky and centrally abdominal	Pain may not be colicky
Vomiting	Early Bilious vomiting and then faecalent due to bacterial overgrowth	Vomiting late
Constipation	Late	Early. May pass diarrhoea if partial obstruction
Abdominal distension	Less if high obstruction and vomits	More severe if low
Abdominal percussion	May be resonant	May be resonant
Bowel sounds	High pitched tinkling
AXR	Central small bowel valvulae coniventae across width of bowel visible. Distended small bowel. Usually centrally. Many short fluid levels on erect film. Often many loops of the small bowel. SB usually < 3 cm and up to 5 cm when obstructed. No gas in the colon.	Peripheral large bowel and haustra do not cross the entire diameter of the wall. Gas in the large bowel. Few loops. Few long fluid levels. Transverse diameter < 10 cm.
Causes	Post surgical adhesions, herniae, volvulus, paralytic ileus, small bowel ischaemia, old irradiation damage , Crohn's disease	Colorectal cancer, Sigmoid volvulus, Diverticular disease

Investigations

FBC, U&E, CRP
Abdominal X ray; Distended bowel before obstruction and no air in rectum

Pathology

Depends on cause

Management

Paediatric surgical referral and definitive management of cause
Nil by mouth, IV fluids , correct electrolytes. Close monitoring

References

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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