Most common surgical emergency in neonates.

Management depends on timely diagnosis Needs radiological assessment Outcome excellent

Refusal to take feed. Vomitting. Abdominal distention. Delayed/failure to pass meconium.

HIGH INTESTINAL OBSTRUCTION proximal to ileum i.e. gastric ,duodenal & jejunal.

LOW INTESTINAL OBSTRUCTION distal ileum & colon.

HIGH INTESTINAL OBSTRUCTION

Rare Usually distal AXR—gas filled stomach without distal

intestinal air. SINGLE BUBBLE SIGN. Can be dx antenatally on ultrasound.

Congenital failure of recanalization. Association with VATER/VACTERL & trisomy

21. Post-ampullary. Bilous vomitting.

On AXR gas filled distended stomach & duodenal cap.

Absent distal bowel gases,

Gastro duodenal distention but distal gases present.

On contrast– slow transit of contrast distally.

Small congenital obstructive membrane with central aperture.

Failure of normal physloiogical herniation in embryo

Leads to narrow mesenteric attachment. Predisposes to rotation around superior

mesenteric vessels. If untreated bowel ischemia & infarction.

Abnormal course of duodenum that fail to cross midline has spiral appearance .

Intestinal ischemia during intra uterine life. Present with bilous vomitting & abdominal

distention.

Distention of stomach ,duodenum & jejunum.

LOW INTESTINAL OBSTRUCTION

Due to intra uterine ischemic insult. Bilous vomiting & distention. Numerous dilated bowel loops.

Meconium plugs obstruct colon & distal small bowel.

Associated with cystic fibrosis. AXR– multiple distended gut loops. Contrast study—meconium plugs & micro

colon.

Meconium plug /small left colon syndrome. Benign & self limiting condition. Due to immaturity of colonic ganglion cells. To infants of diabetic mothers & those who

took MgSO4 for pre eclampsia.

Contrast studies- dilated ascending & transverse colon small descending colon rectum normal

Arrest of neuron migration to distal bowel before 12th week.

rectosigmoid-75% splenic flexure-20% whole colon-5%

Affected segment narrowed. Proximal dilatation.

Rarely an uncommon condition Intra uterine vascular insult Proximal to splenic flexure

Association with VATER High/low depending levator ani muscle Low –blind ending pouch. High-associated with fistula to

bladder,urethra & vagina.