Intestinal obstruction in newborns is an unpleasant pathology in which there is a complete or partial blockage of the large or small intestine. It complicates the passage of fluids, food and gas along the standard path, bypassing the intestines. Often, blocking provokes severe pain, which sometimes occurs, then disappears. Obstruction occurs in one child out of one and a half thousand. At the same time, this ailment is so serious that it is worthwhile to suspect it in any child, without exception, if it constantly vomits, there are abdominal pains, characteristic bloating. Untimely treatment can lead to fatal consequences.
Features of the disease
Intestinal obstruction in newborns, if not controlled and treated, can lead to vascular damage in the intestine. Because of this, his tissues die, blood supply decreases, the walls are destroyed, which as a result leads to infection of the whole organism. In some cases, it is fatal.
Intestinal obstruction in newborns can be caused by various pathological processes. At the same time, acquired and congenital obstruction is distinguished.
Congenital bowel obstruction in newborns is provoked by malfunctions during the development of the baby in the womb. This can lead to: impaired intestinal rotation during the formation of the gastrointestinal tract, intestinal malformations, pathology of other organs located in the abdominal cavity.
Acquired obstruction becomes a consequence of an operation or an inflammatory process in the body.
Types of obstruction
Doctors distinguish several types of intestinal obstruction, depending on certain criteria. What matters is the absence or presence of a specific physical obstacle. In this case, mechanical and dynamic obstruction are shared. With mechanical blockage of the intestine occurs with scar tissue, a tumor or other block, which prevents the contents of the intestine from penetrating through the point of blockage. With dynamic obstruction, muscle contractions cease altogether or are partially disrupted.
By the level of the affected area of the intestine, low and high obstruction are distinguished. If the first becomes a consequence of stenosis of the small intestine or atresia, then the second occurs due to stenosis of the duodenum 12.
In terms of patency, there is a partial bowel obstruction in a newborn, when a small amount of stool still passes, and complete when there is no stool at all.
According to the speed of development of symptoms, chronic and acute obstruction are distinguished. In chronic, symptoms develop slowly, and in acute - as rapidly as possible.
Causes
If the main causes of intestinal obstruction in newborns are hernia, inversion, invagination and adhesions, then the problem should be sought in the small intestine.
Obstruction in the thick appears due to swelling, intestinal inversion, diverticulum. Often such a disease appears in very young children. Bowel obstruction in children up to a year occurs due to inversion, intussusception and hernia. At the same time, it is especially difficult to diagnose the disease, since the kids can not yet formulate what specifically bothers them.
Now we will tell in more detail about those or other reasons. Intestinal obstruction in newborns provokes Hirschsprung's disease. This is a motor disorder that affects up to 25% of infants with characteristic intestinal obstruction. In some cases, symptoms appear only in late infancy or later in adulthood.
In such patients, the body does not have ganglia - special nerve cells in the walls of the large intestine. This affects the wave-like movements that promote the movement of food. The first sign of this disease in most babies is the lack of stool with meconium for 48 hours after birth. Other signs later appear. For example, a distended stomach, chronic constipation, lack of appetite, developmental delay, vomiting. The solution to this problem, as a rule, is to surgically remove part of the colon.
Ideally, the operation should be performed before 6 months of age. This ailment is directly related to some with other congenital conditions, including Down syndrome.
Meconium obstruction is associated with primordial feces, which is called meconium. It is fibrous and atypically dense, so it comes out with difficulty. Ideally, such feces should consist of bile and mucus. Unhealthy meconium blocks the intestines. It has to be eliminated with the help of surgical intervention or an enema.
This condition occurs due to a lack of digestive enzymes in the body that are formed in the pancreas, such as trypsin. Because of this problem, the baby develops cystic fibrosis.
Bowel obstruction in a newborn baby appears due to intestinal inversion. This condition often occurs in young children, when there is an independent twisting of the large or small intestine.
When twisting the duodenum, a duodenal closure forms. In this state, the section of the intestine connecting the small intestine and stomach twists. As a result, the blood flow in the intestinal loop is disrupted (the so-called strangulation actually begins), a decrease in the flow of oxygen into the tissue provokes gangrene. The intestinal tissues simply die. In a quarter of cases, suffocation is possible. This is a dangerous ailment that can progress to gangrene within 12 hours.
Another dangerous cause of obstruction is intussusception. In this case, the intestine, as it were, develops into itself, as it happens with a household antenna for a radio. This condition is typical for babies from three months to 6 years of age.
Hernia can also block part of the intestine. In this case, they tightly block the passage of food.
Post-surgical and congenital adhesions are another cause of obstruction in children. Adhesions look like strips of fibrous tissue that connect to the abdominal organs, to each other, and to intestinal loops. Because of this, the distance between the walls of this organ is significantly limited, the passage of food becomes impossible.
If in adult patients, adhesions most often occur after surgery, then in children adhesive adhesions may appear after surgery on the abdomen.
Symptoms
It is often difficult to diagnose this disease, since the symptoms of intestinal obstruction in newborns are different. Ultimately, it all depends on the type of blockage and localization.
There are several sure signs that help determine where the problem occurred. If vomiting occurs almost immediately, and constipation overcomes the baby, then the affected area should be sought in the small intestine. With blockage of the small intestine, the symptoms of intestinal obstruction in a child develop faster, but the symptoms in the colon appear gradually, usually they are milder.
The main difficulties arise with the diagnosis of this or that type of obstruction in infants, since they cannot tell what is bothering them. Therefore, their mothers and fathers should be especially careful to monitor changes in the child, which may indicate a problem.
One of the earliest signs of intestinal obstruction in children is wave-like cramping and pain in the abdomen. They either reappear or disappear. At the same time, the baby squeezes his legs under himself and even cries, it hurts him so much. Between attacks, he can behave calmly for up to 30 minutes. After the pain and tears come back again. Such discomfort appears due to the inability of the intestinal muscles to promote already digested food through the obstacle that has appeared.
Another classic symptom of bowel obstruction in newborns is blood in the stool, which appears immediately after an attack of crying. Typical of this condition will be vomiting. When it appears helps to understand the location of the problem. If the baby begins to feel sick immediately after an attack of pain, then the problem is in the small intestine, and if after some time, then in the large. A characteristic sign of intestinal obstruction in a newborn is green vomit.
When absolute blockage of the intestine occurs, the child is not able to pass feces and gas. However, if the obstruction is partial, he may have diarrhea. For this ailment, fever is uncharacteristic.
Complications
It is important to treat this disease in a timely and effective manner, otherwise you cannot avoid dangerous complications. If the contents of the intestine cease to pass through obstacles, the body begins to consume too large volumes of liquid from the intestinal lumen. Because of this, the skin in the abdomen becomes stretched and shiny, pain occurs on palpation. Due to constant vomiting, the body is dehydrated.
Fluid imbalance provokes an imbalance in the important chemical elements that are contained in the blood. These are electrolytes. Because of this, complications associated with an irregular heartbeat appear. If it is not possible to quickly restore the electrolyte balance, there will be a shock.
Another dangerous complication is renal failure. It appears as a result of systemic intoxication due to impaired intestinal integrity or dehydration. Therefore, it is important to identify pathology in the early stages in order to conduct effective treatment.
Diagnostics
In childhood, it is extremely difficult to diagnose bowel obstruction, since the child often cannot clearly formulate his complaints. Therefore, a whole complex of examinations and the delivery of various analyzes are carried out.
The basis, of course, is a visual examination of the patient. The doctor begins to suspect the presence of this problem, if a lump can be felt in the stomach, it becomes too sensitive to palpation, outwardly swollen. Sounds in the intestines can be heard with a stethoscope.
Radiography of the abdomen is recommended to confirm the diagnosis. However, this is a rather inaccurate method in which some obstacles may simply not be noticed. But computed tomography allows you to get a cross-sectional image taken from several different angles.
In childhood, ultrasound is the preferred method. In this case, the child will be inflicted the least harm.
In some cases, the doctor may introduce air or liquid barium through the rectum into the large intestine. This will be called a barium or air enema. If the baby has intussusception, this can help eliminate the problem, then no further treatment will be required.
Treatment methods
Patients with suspected this pathological condition are required to be hospitalized. Treatment of bowel obstruction in children should be started immediately to prevent pinching of the intestinal loops. This can be fatal.
There are a lot of methods to combat this ailment. Moreover, one of the first is almost always the introduction of a nasogastric tube through which all contents are removed from the intestine and stomach. Then, intravenous fluids are administered to the patient to eliminate electrolyte imbalance and stop dehydration.
In some cases, it is possible to avoid surgery for bowel obstruction in a newborn. For example, in the case of intestinal torsion, a rectal tube inserted into the intestine helps. In more than half of cases, a barium enema helps newborns.
A gastrograph is also used. This is a contrast agent that not only has a powerful therapeutic effect, but is also able to improve the quality of the intestinal scan.
Sometimes an air enema helps against partial obstruction. It is worth noting that after any of these procedures, the baby is left for inpatient treatment for several more days to observe its condition.
Operation
It is sad, but in most cases, an operation is required for bowel obstruction in a newborn. If the situation could not be corrected by other methods, this is inevitable.
As a rule, surgical surgery requires complete obstruction. With partial in most cases, it is possible to cope without it. An emergency operation is prescribed if there are infringed places of the intestine. Part of the intestine is excised, the affected area is completely removed.
When a tumor, scar tissue or polyps become the cause of obstruction, they also require urgent removal. Hernias are removed to restore bowel patency.
In parallel, drug treatment with antibiotics is used. They are prescribed both before and after the operation. This eliminates the likelihood of infection at the site of obstruction. In parallel, the body is replenished with intravenous fluid, if necessary.
Avoids many dangerous effects of surgery for bowel obstruction in newborns. Immediate intervention by an experienced surgeon often becomes the only chance to correct the obstruction.
As an alternative therapy, they recommend a special diet with a significant fiber content, which helps stimulate the correct formation of stools.
Forecast
According to patients who themselves have encountered such a problem, in the vast majority of cases, obstruction can be overcome with the help of timely qualified medical care. Then the chance is great that the child will recover without consequences for the body. If you do not pay attention to obstruction, it can be very dangerous, even fatal.
One of the consequences of this condition is infection of the whole organism. In this case, the intestine loses its integrity or gets pinched. There are many tactics for medical treatment of intestinal torsion, but in this case the probability of relapse reaches 80%.
Prevention
The good news for parents of babies is that most often obstruction is actually preventable, initially not allowing the appearance of this pathological condition. Timely surgical removal of polyps and tumors in the intestine helps to avoid relapse. In this case, adhesions can form after the operation, turning into another cause of obstruction.
In order to prevent some types of problems associated with obstruction, you should adhere to a proper diet. Eat enough fiber, as it is it that contributes to the formation of normal stool and the constant release of the intestines.
Dietary nutrition must include fresh and dried fruits, especially apples, prunes, lentils, beans, seeds, nuts, raw vegetables, and foods with a lot of coarse fiber. The latter include cereals and whole grain bread.
In a baby, the definition of intestinal obstruction directly depends on various related symptoms. Be sure to remember that a healthy diet, as well as a large amount of water that should be drunk throughout the day, will maintain the health of your intestines.
Parents are required to monitor the work of their child’s body. Inform the pediatrician of all abnormalities. This will help to avoid many problems with the health of children.