Acquired Causes of Obstruction - Paediatrics

Acquired Causes of Obstruction

·        In addition to congential causes above (malrotation ® volvulus, atresia, etc):

o  Hernias

o  Adhesions (always ask about previous surgery)

o  Intussusception

o  Volvulus

Intussusception

·        Peak incidence 3 months – 2 years

·        Usually ileocolic

·        Causes:

o  95% idiopathic

o  5% mechanical: intestinal polyp, Meckel‟s diverticulum, lymphosarcoma (> 6 years old)

·        Symptoms:

o  Often URTI 10 days before (® adenovirus in Payer‟s patch)

o  Initial: severe abdominal colic every 15 – 30 minutes, very well in between

o  Later: red-current jelly stools, prostration, pallor (shock) 

·        Exam: sausage shaped mass ® clinical diagnosis

·        Treatment: 

o  Hydrostatic reduction: blow air or barium up anus at 50% diastolic pressure. Not if small bowel obstruction or peritonitis (barium in peritoneum is nasty)

o  Surgery