Which obstruction predominates in childhood? Intestinal obstruction in infants: signs, treatment

Intestinal obstruction is a pathological condition of the digestive system, which is characterized by slow movement of stool.

In the absence of timely treatment, this process stops completely. Treatment methods and duration of treatment directly depend on the timeliness of diagnosis, the stage of development of the disease and the age of the child.

For emergency care for a baby surgery may be prescribed. Intestinal obstruction is one of the pathologies that pose a threat to the patient’s life. We will talk about the symptoms of intestinal obstruction in children in this article.

general characteristics

Intestinal obstruction is a result disturbances in the movement of its contents through the intestinal tract.

The pathological condition is provoked by a deviation in the motor ability of the digestive organs or a mechanical obstacle.

The risk of developing intestinal obstruction can develop gradually (against the background of congenital or acquired diseases of the gastrointestinal tract) or occur suddenly (for example, when a foreign body enters a child’s esophagus).

Features of intestinal obstruction:

the pathological process can be acute or chronic;
blockage of the intestinal lumen can be complete or partial;
obstruction may occur in the area of the small intestine or the bauhinian valve.

Causes

Factors that provoke the development of intestinal obstruction in children under one year of age and at an older age differ.

In newborns, the causes of this disease are disturbances in the formation of certain internal systems during intrauterine development.

The diagnosis of intestinal obstruction in most cases is made in the first days after the birth of the child.

In older children, the pathological process develops against the background of certain diseases, consequences of exposure to negative external factors or genetic predisposition.

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Classification of the disease

Intestinal obstruction can be congenital or acquired. In the first case, the disease is provoked abnormalities of the digestive tract system, which begin to develop in a child even at the stage of intrauterine formation of the body.

In the second case, intestinal obstruction leads to certain factors, which have a negative effect on the baby’s digestive organs after birth.

Classification of intestinal obstruction depending on the mechanism of development:

mechanical type (presence of obstacles partially or completely blocking the intestinal lumen);
strangulatory type (congenital pathology of the mesentery);
dynamic type (impaired intestinal motility).

In medical practice, the development of intestinal obstruction is divided into three stages. The initial stage lasts several hours and is accompanied by flatulence combined with pain in the abdomen.

The second stage of the disease is characterized by a decrease in symptoms, but the relief is temporary. At this stage, a powerful intoxication of the baby’s body occurs, which can progress over several days. The third (thermal) stage develops in the form of an attack.

Symptoms and signs

How to understand that a child has intestinal obstruction? Intestinal obstruction never develops asymptomatic.

If a child retains stool, bloating and other signs of defecation disturbance occur, the baby must be shown to a doctor as soon as possible.

An attack of intestinal obstruction occurs suddenly and is accompanied by sharp cramps in the abdomen.

This condition causes severe pain to the child, which provokes loud crying. In the absence of timely medical care for this condition, there is a risk of death for the baby.

Symptoms of intestinal obstruction may develop in children of any age.

In the congenital form of the pathology, its signs appear approximately two days after the birth of the baby.

The first sign is vomiting. The intensity of development of other signs depends on the general clinical picture of the child’s health. In some cases, all symptoms appear at the same time.

Symptoms of intestinal obstruction manifests itself in the following conditions:

sharp acute pain in the abdominal area;
increased salivation;
vomiting and nausea;
vomit contains fecal impurities;
and flatulence;
lack of stool for a long time;
compaction in the abdominal area;
rapid breathing and heart rate;
increased body temperature;
there are blood impurities in scanty stools;
stable asymmetrical;
decreased urine production;
signs of dehydration;
lack of appetite.

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Consequences and complications

The most dangerous complication of intestinal obstruction is death of a child.

As the pathological process progresses, the baby’s body becomes intoxicated.

The blood supply to the tissues of the digestive organs is significantly disrupted. The consequence becomes destruction of the intestinal walls.

During an attack of intestinal obstruction, a situation may arise when it is not possible to save the child even with surgery.

Other complications intestinal obstruction in children:

severe dehydration of the body;
disruption of vital systems;
renal failure.

Diagnostics

Two specialists are involved in the diagnosis of intestinal obstruction - pediatrician and surgeon. If it is necessary or difficult to identify the disease, other specialized doctors may be involved.

Suspicion of intestinal obstruction in a child may arise based on his general examination and medical history. To confirm the diagnosis, laboratory research methods and additional procedures are required.

Diagnostics carried out using the following methods:

X-ray of the abdominal organs;
General and biochemical analysis of blood and urine;
laparoscopy;
CT or MRI of the abdominal cavity;
air or barium enema;
Ultrasound of the abdominal organs.

Treatment methods

Therapy for intestinal obstruction depends on the stage of progression of the pathological process.

If the diagnosis was established within the first six hours, then treatment may be limited to conservative methods.

In case of late diagnosis, in most cases the surgical intervention technique is immediately used. Folk remedies are a good addition to any type of therapy, but they should never be used as the main way to eliminate intestinal obstruction in children.

Conservative therapy

Conservative treatment for intestinal obstruction in children is based on the use of special drugs that normalize the general condition of the child and improving the movement of feces on the digestive organs.

The medications used should eliminate stagnation in the intestines and eliminate intoxication of the child’s body.

Medicines are prescribed only by a specialist based on the general clinical picture of the young patient’s health condition.

Examples of drugs used to treat intestinal obstruction in children:

drugs to stimulate intestinal functions (Proserin);
antispasmodics (No-shpa, Papaverine);
laxatives (Fitomucil);
laxative glycerin suppositories;
antiemetics (Domperidone, Cerucal);
intravenous administration of water-salt solutions;
enemas with hypertonic solutions.

Before using drugs, the child must be prescribed conservative methods to correct his condition.

Such measures include bowel emptying using a permanent probe, lavage, intravenous stimulation with special solutions and ganglion blockade.

Forty minutes after such procedures, the baby is given siphon enema. The child’s condition is monitored with regular x-ray examinations.

Surgical intervention

The need for surgical intervention for intestinal obstruction arises in the absence of effectiveness of conservative therapy or too late diagnosis of the pathological process.

The purpose of the surgical procedure is to remove the area of intestine affected by the progression of the disease.

The surgeon removes the blockage and takes measures to prevent recurrence of the disease.

Folk remedies

Alternative medicine recipes are applied as an adjunct at any stage of therapy intestinal obstruction. After an attack, such remedies help improve the baby’s general condition, and after surgery, they help to recover faster and improve the functioning of the digestive system.

When selecting recipes, it is important to take into account the individual characteristics of the child. Some ingredients may cause food intolerances or allergic reactions.

Examples of folk remedies:

Diet

Intestinal obstruction involves following a strict diet. In the first days of disease progression and after surgery for children therapeutic fasting is recommended. Eating food is allowed only from the third day and in minimal portions.

Products that can cause difficulty in digestion should be completely excluded from the menu.

You need to prepare dishes only by steaming or cooking. The child’s diet should contain the following products:

porridge;
jelly;
rosehip decoction;
fermented milk products;
boiled beets and carrots;
fruit jelly;
light broths;
lean varieties of meat and fish (in pureed form).

Prevention of the disease

In some cases, prevent the development of intestinal obstruction impossible.

For example, if a child has a congenital form of the disease or the progression of diseases that provoke closure of the intestinal lumen and are difficult to treat.

Preventive measures include the following recommendations:

Timely removal of adhesions and polyps in the child’s intestines.
Regular examination of the baby by specialized specialists.
Monitoring the child's diet.
If you have abdominal pain, nausea or vomiting, you should consult a doctor.
If the child’s frequency of bowel movements and urination has decreased, then a visit to a specialist should not be postponed under any circumstances.

With timely diagnosis and complete treatment of intestinal obstruction, it is possible to completely eliminate the risk of complications. There are no negative consequences that change the child’s quality of life.

If the diagnosis is not confirmed in a timely manner, then the prognosis for parents will be unfavorable. Damage to certain areas of the intestine can cause the development of serious diseases of the digestive system in adulthood.

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You can learn about intestinal obstruction in children from the video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

Intestinal obstruction is a violation of the movement of intestinal juices and digested food through it. The disease can cause many dangerous complications, especially in children. Intestinal obstruction in newborns in almost all cases requires urgent surgical intervention.

The disease is common in children and in most cases is associated with gastroenterological problems. The complexity of the course always depends on where in the intestine the blockage has formed - the higher it is, the more acute the symptoms of the disease in the child and the more difficult it is to treat.

The onset of the disease is characterized by rapidity: symptoms appear within a short period of time and quickly intensify.

Intestinal obstruction can be not only acquired, but also congenital, which is associated with anomalies and pathologies of the development of the gastrointestinal tract in the prenatal period.

Acquired obstruction has various causes, depending on which the disease is divided into two types: mechanical disorder and dynamic.

Mechanical type obstruction occurs when tumors or hernias form in the abdominal cavity, blocking the intestines and preventing its normal functioning. The disorder may also appear after certain operations during the formation of adhesions, illnesses, and even taking certain medications as a side effect.

Mechanical obstruction in a child also includes conditions such as volvulus and intussusception, when one of the sections of the intestine penetrates into the underlying area and forms a blockage.

In most cases, mechanical obstruction occurs in the small intestine, but sometimes blockage of the large intestine can occur. The causes may be diseases, for example, colon cancer, volvulus, diverticulitis, narrowing of the lumen caused by scarring or inflammation, severe compaction of stool.

Dynamic obstruction is divided into:

spastic, caused by prolonged tension of the intestinal walls;
paralytic or functional, caused by complete relaxation of the intestines.

Functional obstruction may have general symptoms and signs, but does not form a mechanical blockage. The intestines cannot function normally due to nervous or muscular disorders, causing a decrease in the number of natural contractions or their complete cessation, which greatly complicates the movement and removal of contents.

The causes of paralytic obstruction in any intestinal section may be:

operations performed on the pelvic and abdominal organs;
some medications;
intestinal infections;
Parkinson's disease and other disorders of a nervous or muscular nature.

Symptoms of intestinal obstruction in newborns

The cause of obstruction in newborns is pathologies of intestinal development, narrowing of the lumen or lengthening of certain areas, as well as individual characteristics of the structure and location of intestinal loops.

Symptoms of the disorder:

severe bloating without passing gas;
retention of meconium stool, its complete absence or meager amount;
vomiting, often mixed with bile;
severe polyhydramnios in the prenatal period.

The causes of disorders can be the presence of diabetes in the mother, as well as small intestinal atresia and Hirschsprung's disease.

If the small intestine or duodenum of a newborn is severely narrowed or there is no lumen, you can observe the discharge of mucous lumps from the rectum. They do not contain any admixture of skin cells of the superficial layers, which are always present in the amniotic fluid and are swallowed by the baby developing inside. Such cells are always present in a baby’s meconium during normal bowel function.

Symptoms in children under one year of age

At this age, in children, the disorder has its own specifics. The most common cause of obstruction in infants is intussusception, when part of the intestine, inverted, enters the lower section and leads to the formation of a blockage. Most often, this condition is observed in boys aged 5 to 10 months. This disorder is rare in older children.

The cause is usually immaturity of the intestine and instability in the functioning of its mechanisms, which, as a rule, goes away as the child grows. Other factors can also lead to disruption of the natural functioning of the intestines, for example, the introduction of a new product into the baby’s diet, a change in diet (a sudden forced transition from breastfeeding to artificial feeding), infections.

Signs of intussusception:

vomit;
frequent attacks of pain in the abdominal area;
the presence of bloody discharge with mucus instead of feces;
bloating;
compactions in the abdominal cavity, clearly palpable upon palpation;
attacks of pain with a sudden sharp appearance and the same ending; after a short time they are repeated, causing babies to cry, scream and become very worried.

In the presence of acute low obstruction caused by the presence of an obstruction in the lower part of the small intestine or in the large intestine, the child has no bowel movements at all, the abdomen is greatly distended due to accumulated gases, and vomit appears, smelling of feces.

Symptoms of children after one year

In children older than one year, the disease manifests itself abruptly, so parents can usually name not only the day the problem occurred, but also the almost exact time. The child develops severe pain in the abdomen, vomiting, while there is no stool and gases do not pass away, the accumulation of which causes visible bloating. Babies cannot sit still, are constantly looking for a comfortable position and may periodically scream in pain.

The type of obstruction can be determined by a set of signs, for example, the closer to the stomach the resulting blockage is located, the stronger the vomiting will be and the sooner it will occur. If the problem is in the large intestine, there is usually no vomiting, but children experience a painful urge to defecate, accompanied by severe bloating, causing babies to cry loudly and hysterically.

In the presence of intussusception, bloody discharge may be observed from the rectum, which indicates tissue damage and severe irritation of the intestinal walls.

If you do not provide timely assistance to the baby, necrosis of intestinal tissue may begin, as evidenced by a decrease in pain against the background of a sharp deterioration in the general condition.

An important sign of the disorder in children older than one year is the presence of Wahl's symptom, when there is a persistent, often asymmetrical swelling of the abdomen, visible to the eye and clearly palpable upon palpation, while the resulting tumor does not move.

Diagnostics

The symptoms of the disorder are pronounced, which allows parents to detect the problem in time and consult a doctor, in this case a surgeon, since only he can accurately diagnose and provide assistance to the child. If it is not possible to see a surgeon, you need to show the child to a pediatrician, but in no case should you self-medicate.

Diagnostic measures include:

Examination of the baby, assessment of his condition, identification of symptoms.
Anamnesis collection.
General blood analysis.
X-ray of the abdominal cavity.
An ultrasound can also be performed, but such a procedure in case of obstruction is not particularly informative.

Treatment

Any type of intestinal obstruction in children requires mandatory hospitalization, since help for children can only be provided in an inpatient setting.

To stabilize the condition:

A dropper with a solution is installed to restore the water-salt balance in the body.
If the baby is bloated, a special probe is inserted through the nose, the purpose of which is to remove accumulated gases and liquids.
A catheter is inserted into the bladder to drain urine and perform tests.

Conservative therapy can be carried out only in cases where the baby has no serious complications due to intestinal obstruction. A set of measures will be aimed at eliminating the existing stagnation in the intestines and eliminating the consequences of poisoning of the body.

Conservative measures include:

Washing the stomach and esophagus through a special probe. The procedure allows you to stop the vomiting process.
Carrying out enemas with hypertonic solutions.
Carrying out siphon enemas using sodium chloride.
Administration of intravenous water-salt solutions.
Introducing air into the baby's rectum during intussusception. The purpose of the procedure is to straighten the formed intestinal fold.
Prescription of medications, antispasmodics, antiemetics, painkillers.
At the end of all procedures, if the problem is successfully resolved, the baby is injected subcutaneously with proserine, which helps stimulate proper intestinal function.

Paralytic forms of obstruction are treated with drugs that cause contractions of the intestinal muscles, which promotes the rapid movement of contents to the outlet, as well as laxatives.

Surgical treatment (operations)

Surgical intervention is resorted to in cases of direct indications for surgery or when conservative treatment methods have not produced the necessary results. The operation is aimed at eliminating the problem, that is, at removing a section of the affected intestine, eliminating the resulting mechanical blockage and taking measures to prevent recurrence of the disorder.

In particularly complex and severe cases, multiple surgeries may be required to clear the obstruction and prevent the problem from occurring in the future.

Lifestyle and nutrition during treatment

During the period of conservative therapy, as well as surgical treatment, the child requires rest and hunger. It is important to ensure that the baby strictly follows the doctors’ instructions and does not take any food without their permission. The same applies to drinking liquids.

After eliminating the obstruction using conservative methods, the small patient is prescribed a special gentle diet that restores normal intestinal function and its microflora. In case of surgery, intestinal function is stimulated with medications, gradually allowing the baby to take light food in small portions.

In the future, hard-to-digest foods, vegetables and fruits, which have a binding effect and cause constipation, should be excluded from the little patient’s diet. The child’s menu should include fermented milk products, cereals, jelly, light meat broths and soups based on them, boiled and steamed lean meat, fruit jellies, rosehip decoction, green tea.

The problem of constipation in children

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How does intestinal obstruction occur in children? A competent doctor can answer this question. Many health disorders begin to appear in early childhood. It is about such a disorder, which is called intestinal obstruction, that will be discussed further.

Reasons for development

From the first days of a child’s birth until he enters a preschool institution, medical personnel monitor the newborn, because precisely because the child is just developing adaptive reactions and developing immune defenses, it is so important to protect him from a certain number of dangerous diseases. But this is not always possible; every now and then problems arise in the functioning of the gastrointestinal tract, in particular intestinal obstruction in children under one year of age.

The presence of severe pain is an early sign of illness. The characteristics of the pain are paroxysmal, sudden onset, and the child may experience discomfort at any time of the day or night. Attacks of pain manifest themselves during the process of peristalsis and resume at intervals of 15 minutes; they do not have a specific localization.

At the time of decompensation (muscles lose energy reserves), the pain becomes permanent. As the disease progresses, the acute pain disappears within 2-3 days. This is a bad sign for predicting the further course of the disease.

Stool retention and gas retention are early symptoms of intestinal obstruction. With the paralytic type of the disease, pain in the abdomen becomes constant and bursting. Acute intestinal obstruction in the case of the initial stage of the disease does not exclude the appearance of stool due to the use of medications, in most cases due to repeated emptying of the intestinal area located much lower than the place where the obstruction is located.

The presence of bloody discharge that occurs in the anus when intussusception is performed. A diagnostic error is often made in the area of diagnosis.

There are often cases when acute intestinal obstruction in children is falsely mistaken for dysentery.

The gag reflexes are uninterrupted, frequent and repeated, sometimes the attacks periodically recur after nausea, and sometimes the relapse is independent.

The occurrence of vomiting attacks is due to the location of the obstacle in the digestive tract: the higher it is, the earlier vomiting occurs. At first, vomiting attacks appear reflexively, and then the symptoms are centralized.

Acquired intestinal obstruction in children and newborns is a serious condition and a more threatening disease than in adults. After all, a child’s body is just acquiring immune mechanisms and mastering techniques to fight infections and pathological microorganisms.

What are the symptoms of the disease?

Intestinal volvulus is accompanied by vivid manifestations of the clinical picture of intestinal obstruction in acute children. Unexpectedly for the child, paroxysmal pain, bloating and rejection of vomit appear in the abdominal area. The pain syndrome is so strong that the child cannot cry or even scream, he can only spin like a top.

If there is a necrotic condition of the compressed wall of the intestinal tract, the pain goes away and the child’s general condition becomes more complicated. Exhausting, incessant vomiting, which occurs if the small intestine collapses, occurs in the first moments of the presence of the disease.

Moreover, its appearance is earlier if the interference is located closer to the gastrointestinal tract. Vomit includes food debris at the initial stages, later it contains bile, and then vomit comes out with bloody impurities.

When an area of the large intestine is affected, vomiting either recedes or comes. There is a painful urge to empty the bowels, and there is bloating with gas retention. Obstruction is likely with diarrhea, in which lumps of normal stool occur. This phenomenon is repeated several times.

The reasons for the manifestation of the disorder are caused by developmental defects - when the intestine and certain areas of it narrow or lengthen, due to the presence of such an arrangement or turns of the intestine, which can cause interference in the movement of food through the gastrointestinal tract.

Harbingers of the disorder and symptoms of the disease:

bloating (the abdomen takes on a scaphoid shape);
vomit containing bile;
scanty stool, there is a possibility of its absence or delay;
no release of gases;
maternal polyhydramnios during gestation;
Down syndrome;
heredity;
small intestinal atresia;
maternal diabetes;
Hirschsprung's disease.

In the absence of a lumen in the colon or duodenum or in the presence of narrowings, the above list of symptoms should include the release of lumps from the rectum, where there are no admixtures of the cellular structures of the surface skin, which are present when the amniotic fluid is released, and the liquid swallowed by the resulting fetus. In the presence of normal intestinal patency, these cellular formations are appropriate as constituent elements in the meconium of newborns.

Intestinal obstruction in infants. In infants, the presence of such a disorder is specific. Intussusception in children is a condition when part of the intestine, everting, invades another intestine. A similar condition may occur in babies 5-10 months old, mainly in males. Children under 1.5-2 years of age can acquire this pathology extremely rarely.

As a result of failure to provide timely assistance, the further course of the above-described disease is fraught with negative consequences. Isolation of a certain part of the intestine, as well as its exclusion from the digestive act, necrosis of certain areas as a result provokes a malfunction in the digestive system and metabolic processes.

A decrease in the protective function of the mucosa provokes an increase in the permeability of the gastrointestinal tract wall for pathogenic microorganisms and their metabolic products. Complicated intoxication occurs, developing into disorders such as peritonitis, sepsis, and multiple organ failure.

Interruption of the absorption process also applies to liquids. An insufficient amount of it in the blood, combined with vomiting, results in dehydration.

The progression of these phenomena is rapid, the process develops over the course of a day and is the cause of death if the patient does not go to a medical institution in the Pediatric Surgery Department.

What to do if intestinal obstruction occurs in a child?

When a child enters a medical facility, it is important to assess his condition and conduct laboratory tests. To make an accurate diagnosis, the patient will need to undergo the following list of tests:

General blood analysis. Indicates an overestimated hemoglobin concentration and an excess of the quantitative ratio of red blood cells - an indicator of dehydration, an increase in white blood cells - a sign of the inflammatory process.
In a biochemical blood test, we are interested in a decrease in the content of potassium and chlorine in the blood fluid, a decrease in the amount of protein in the blood plasma, the content of nitrogenous compounds, a shift in the acid-base balance towards excess alkali or blood oxidation.
X-rays are performed immediately. Using this method, you can clearly see the consequences of volvulus. According to the image, the doctor can approximately tell where exactly the failure occurred.
An x-ray makes it possible to show where the obstruction has formed.

If there is a violation, only an experienced doctor can provide assistance. Depending on the degree of development of the pathology, there is a varied approach to treating the disease, in particular, surgical intervention is applicable.

Intestinal obstruction in children is a common disorder that occurs among various age groups. The disease is an abnormal functioning of the gastrointestinal tract and is characterized by a violation of the movement of food particles or other intestinal contents through the rectum. Among reported cases, the disease is more often diagnosed in boys than in girls. The main age for the development of this pathology is the first year of life.

The disease can be either congenital or acquired. There may be several factors contributing to the formation - premature initiation of complementary feeding for infants, poor nutrition and lack of diet, individual structural features of this organ and the occurrence of inflammatory processes of various natures.

Clinical manifestations can occur in a seemingly completely healthy child. Symptoms are paroxysmal in nature and are expressed in significant pain, inability to defecate, attacks of vomiting and nausea. An increase in temperature is often observed.

Diagnostic measures consist of a whole range of tools and include a physical examination, laboratory and instrumental examinations. Treatment of such a disease in a child is carried out through the use of medications and surgical intervention.

Etiology

The predisposing causes of the disease depend on the age group of children. Intestinal obstruction in newborns is caused by:

improper and early feeding of infants, before four months;
lack of a normal diet in children of the first year of life;
delayed introduction of complementary foods, as well as prolonged feeding with breast milk only;
insufficient formation of the gastrointestinal tract;
structural features of the gastrointestinal tract, in particular the intestines;
congenital elongation of this organ, as well as a wide range of disorders during the period of intrauterine formation;
the presence of intestinal diseases of an inflammatory nature.

In children over 2 years of age, the following sources can be identified:

the formation of benign or malignant neoplasms;
the presence of fecal stones - the masses harden due to a disturbance in the digestive process or a diet inappropriate for the age group;
formation of polyps on the membrane;
entry of a foreign body into the intestine, which leads to blockage of the lumen of this organ;
the occurrence of adhesive or scar disease, as well as ailments of the genitourinary system;
volvulus;
complications after medical intervention;
immobilization of the large or small intestine;
intussusception is a condition during which the penetration of one part of the intestine into the lumen of another occurs.

Classification

Modern pediatric gastroenterology knows several types of intestinal obstruction in children. According to the nature of origin, the disease is divided into:

congenital obstruction– occurs as a result of intrauterine pathologies in the development of the gastrointestinal tract in a child, which is why the baby experiences symptoms of the disease from the first days of life. To prevent the recurrence of the disorder, patients are advised to lead an active lifestyle and follow a healthy diet;
acquired obstruction– the main source of appearance is intussusception. This form, in turn, is divided into several types. It is diagnosed mainly in infants from the fourth month to one year of life. It differs in that the appearance of symptoms is abrupt and unexpected. In children over 2 years of age, the disease can occur, but is rare.

Acquired intestinal obstruction in children is divided into several types:

mechanical– occurs due to tumors and fecal stones. In this case, there is a manifestation of severe, cramping pain and disruption of the circulatory process. This may lead to tissue death and peritonitis;
dynamic– this type of disease develops against the background of previous injuries or operations;
adhesive– based on the name, the pathology is provoked by the presence of adhesions and inflammation in the abdominal cavity. This is the most common form of this disease in children;
obstructive;
strangulation– the main reasons for the appearance are considered to be improper diet, increased intra-abdominal pressure, prolonged fasting, followed by congestion of the stomach.

According to the nature of the spread of the pathogenic process, the disease is divided into several forms:

complete obstruction– often this type is formed as a result of congenital intestinal obstruction and operations designed to eliminate it;
partial obstruction– differs in that the intestinal lumen is not completely closed. This type can be quite difficult to detect, which is why therapy begins at a later stage.

According to the nature of its course, intestinal obstruction in newborns and children under 2 years of age is divided into:

acute– is a consequence of various gastrointestinal disorders, hernias and intestinal tumors. Develops to the terminal stage within 24 hours, which is why medical care should be provided as soon as possible after the onset of symptoms;
chronic- has a lighter flow. Children suffer from pain in the lower abdomen and constant constipation. The body gradually becomes exhausted.

Depending on the intussusception, acquired or congenital intestinal obstruction occurs:

small intestinal;
colonic;
small-colic– in which part of the small intestine is introduced into the large intestine.

Symptoms

Acute intestinal obstruction in children manifests itself abruptly and unexpectedly. Each type of disease has a characteristic manifestation, but there is a group of symptoms that accompanies any course of the disease. Symptoms of the disease are:

pain syndrome is cramping in nature. During an attack, the pain is so intense that children often experience pain shock;
attacks of nausea with frequent vomiting. Excessive vomiting does not provide relief to the baby’s condition. If the large intestine is affected, vomiting may be absent altogether;
disruption of the process of defecation, or rather, complete retention of stool. Children suffer from constipation, which can only be relieved with an enema;
increase in abdominal size;
increase in body temperature;
increased gas formation;
decreased appetite;
the stomach ceases to be soft and elastic, which is why it takes on an irregular shape;
signs of dehydration.

If help is not provided to the child in a timely manner, the above symptoms become more intense.

Diagnostics

To establish the correct diagnosis, a small patient will need to undergo a whole range of laboratory and instrumental diagnostic techniques. But before prescribing them, the doctor needs to independently perform some activities:

study the medical history, analyze the life history of the child and immediate relatives - this will help determine some of the causes of the disease, as well as distinguish congenital intestinal obstruction from acquired one;
conduct a thorough examination of the child, with obligatory palpation of the abdomen, and interview the parents regarding the first time of appearance, as well as the degree of intensity of symptoms.

After this comes the stage of laboratory research, which includes:

assessment of feces - with such a disorder, it acquires a reddish tint and contains blood impurities;
general and biochemical study of blood - a way to detect changes in its composition and associated disorders;
analysis of stool for occult blood - if internal hemorrhages are suspected;
general urine analysis.

But the basis of diagnosis is instrumental examinations, which involve performing:

Ultrasound will make it possible to detect intussusception and other internal causes of the disease;
X-rays with contrast - procedures to identify specific signs of intestinal obstruction.

Treatment

After receiving and studying all the examination results, the specialist prescribes the most effective method of treatment. There are two of them - conservative and surgical.

Before performing drug therapy, the small patient is advised to ensure complete rest, therapeutic fasting, after which dietary nutrition is applied. In addition, conservative therapy includes:

probing – necessary to free the digestive tract from food accumulation. This can relieve the baby from gagging;
injections of solutions to restore water-salt balance;
use of enemas;
introduction of air into the rectum - which helps to straighten the intussusception;
taking painkillers, antispasmodics and antiemetics;
subcutaneous administration of substances to stimulate intestinal function.

In cases of ineffectiveness of previous treatment methods or in severe cases of the disease, medical intervention is prescribed. This method of treatment is carried out by specialists from the field of pediatric surgery. The operation is aimed at removing mechanical blockage, excision of dead intestinal tissue and preventing relapse of the disease.

In addition, complex therapy includes adherence to dietary nutrition. In cases where the disease is eliminated surgically, the patient is prohibited from eating and drinking for twelve hours. After which, gentle nutrition will consist of principles such as:

complete exclusion from the baby’s diet of foods that contribute to increased gas formation;
refusal of confectionery products, pickles, fatty meats and fish. It is not recommended to give boiled pasta and raw vegetables;
all dishes should be boiled or steamed, preferably in a puree state;
You can drink warm green tea. It is forbidden to give your child cold and carbonated drinks.

There is no specific prevention of acquired or congenital intestinal obstruction in newborns and children in the first year of life. It is only necessary to introduce complementary foods in a timely manner and, if the first symptoms occur, immediately seek help from specialists.

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Dyspepsia in children is a fairly common disease characterized by disruption of the digestive process. Often this disease is diagnosed in children in the first year of life, and the severity of the disease directly depends on the amount of food consumed. This is due to the fact that the volume of food consumed does not always correspond to the capabilities of the gastrointestinal tract. There are several varieties of this syndrome in children - simple and toxic. In the first case, the functioning of the gastrointestinal tract is disrupted, in the second, metabolic disorders are observed.

Undiagnosed or improperly managed obstruction leads to damage to the intestinal vascular system. This reduces its blood supply, followed by tissue death, destruction of intestinal walls, and infection of the entire body. This can be fatal.

Types of intestinal obstruction in a newborn: criteria for classification

Many different pathological processes can cause intestinal obstruction in children.

There are congenital and acquired obstructions. Congenital intestinal obstruction is caused by a violation of the intrauterine development of the child.

Its reasons may be:

embryonic intestinal malformations;
disruption of the process of intestinal rotation during the formation of the gastrointestinal tract;
pathology of development of other abdominal organs.

Acquired intestinal obstruction in children is a consequence of inflammatory processes or surgery.

There are several classifications of intestinal obstruction according to various criteria:

1) Presence or absence of a physical obstacle

Intestinal obstructions are divided into: mechanical and dynamic.

mechanical obstruction is a physical blockage of the intestine by a tumor, scar tissue, or other type of blockage that prevents intestinal contents from passing through the point of blockage;
dynamic obstruction occurs when the healthy wave-like contractions of the muscles in the intestinal walls (peristalsis) that move digestive products through the gastrointestinal tract are disrupted or stop altogether.

2) Level of the affected intestinal area

This high and low intestinal obstruction:

high intestinal obstruction in newborns is observed with atresia (fusion) or stenosis (narrowing) of the duodenum;
Low intestinal obstruction may result from atresia or stenosis of the small intestine, ileum, and ascending colon.

3) Degree of obstruction:

complete intestinal obstruction. With it, there is an absolute absence of stool;
With partial obstruction, a small amount of stool passes.

4) Rate of development of symptoms:

acute intestinal obstruction in children is characterized by rapidly developing symptoms;
chronic. It is characterized by slowly developing symptoms, pain may not appear. More common with high intestinal obstruction.

Symptoms of intestinal obstruction in acute form, unlike chronic ones, progress slowly, but tend to suddenly intensify or accelerate.

5) Number of points of obstruction:

simple obstruction. This is when there is a disturbance in the movement of intestinal contents due to the presence of a physical obstruction blocking the lumen, but the contents of the lumen can move backwards;
closed loop. This occurs when the intestinal lumen is blocked at two points where the intestinal contents are unable to move forward or backward;
strangulated obstruction. Occurs when there is a disruption in the blood supply to the blocked segment.

The most common causes of small intestinal obstruction in children are may be the following:

intussusception, volvulus, adhesions;
hernia.

The most common causes of large intestinal obstruction are:

volvulus;
tumors;
diverticula. These are small pouches that form in the intestinal wall that can fill with digestive waste and expand, blocking the intestines.

Mechanical obstruction in children under one year of age may occur due to intussusception, volvulus, and hernia.

Meconium ileus

Meconium ileus in newborns is a disorder in which the meconium (original stool) is abnormally firm and stringy, rather than a collection of mucus and bile that is usually easily passed. Abnormal meconium blocks the intestines and must be removed with an enema or surgery.

This is due to a deficiency of trypsin and other digestive enzymes produced in the pancreas. It is also one of the early signs of cystic fibrosis developing in a baby. Intussusception usually follows an infection, which causes an increase in the size of the lymph node in the intestine, which acts as a folding point for intussusception.

Hirschsprung's disease

Hirschsprung's disease (congenital megacolon), possibly associated with meconium ileus, is a motility disorder that occurs in up to 25 percent of newborns with dynamic intestinal obstruction, although symptoms may not develop until late infancy or childhood, delaying diagnosis.

Children with Hirschsprung's disease lack nerve cells (ganglia) in the walls of the large intestine. This seriously affects the wave-like movements that propel digested food. In most cases, in children with this disease, the first sign is the absence of stool containing meconium in the first two days after birth.

From birth to two years, these babies will develop other signs such as chronic constipation, occasional small amounts of watery stool, distended abdomen, poor appetite, vomiting, poor weight gain, and developmental delays. Most children will need surgery to remove the affected part of the colon.

Surgery can be performed at the age of six months, or immediately after the correct diagnosis is made in an older child.

Symptoms can be resolved in at least 90 percent of those born with Hirschsprung disease. The disease is sometimes associated with other congenital conditions, e.g.

Volvulus

Volvulus is the self-twisting of the small or large intestine (malrotation). Colon volvulus rarely occurs in young children. This usually occurs in the sigmoid colon, the lower part of the large intestine.

Duodenal seal

A duodenal seal occurs when the duodenum, the section of intestine that connects the stomach and small intestine, twists. Twisting of any part of the intestine interrupts the blood supply to the intestinal loop (suffocation), reducing the flow of oxygen to the tissues (ischemia) and leading to the death of intestinal tissue (gangrene).

Strangulation occurs in approximately 25% of cases of intestinal obstruction and is a serious disease that progresses to gangrene within half a day.

Intussusception

Intussusception is a condition where the intestines fold in on themselves, like a radio antenna. Intussusception is the most common cause of intestinal obstruction in children from three months to six years of age.

Adhesions and hernias

Hernias can also block part of the intestine and block the passage of food.

Congenital or post-surgical adhesions also lead to intestinal obstruction in children. Adhesions are strips of fibrous tissue that connect to each other or to abdominal organs and intestinal loops. Thus, the space between the walls of the intestine narrows, and, pinching parts of the intestine, the passage of food is blocked.

In adults, adhesions are most often caused by surgery. Children who have undergone abdominal surgery may also develop adhesive intestinal obstruction. It is not known exactly what causes the abnormal growth of fibrous tissue in congenital adhesions.

Symptoms of intestinal obstruction vary.

Some are more common or appear earlier than others. It depends on the location and type of blockage.

Vomiting usually occurs early, followed by constipation. This is typical when the small intestine is involved.
Early onset, accompanied by vomiting, is more typical for colonic blockage.
Symptoms of a small bowel blockage tend to progress more quickly, while symptoms of a large bowel obstruction tend to be milder and develop gradually.

It is difficult to diagnose one or another type of intestinal obstruction in infants, since young children are not able to describe their complaints.

Parents need to monitor their child for changes and signs indicating obstruction.

The first signs of mechanical type intestinal obstruction are abdominal pain or cramps, which appear and disappear in waves. The baby, as a rule, clenches his legs and cries in pain, and then suddenly stops. He may remain calm for a quarter to half an hour between bouts of crying. Then he starts crying again when another attack comes. Cramps occur due to the inability of the intestinal muscles to push digested food through the blockage.
The classic symptom of intussusception is bloody stool in infants after a crying attack.
Vomit- another typical symptom of intestinal obstruction. The time of its appearance is the key to the level of the obstacle. Vomiting follows soon after pain if the blockage is in the small intestine, but is delayed if it is in the large intestine. The vomit may be green in color from bile or appear fecal in nature.
When completely blocked The baby's intestines will not pass gas or feces. However, if the obstruction is only partial, diarrhea may occur.
At the onset of the disease absent.

Complications from obstruction

When the contents in the intestines do not pass the obstruction, the body absorbs a lot of fluid from the intestinal lumen. The abdominal area becomes painful to the touch, the skin there looks stretched and shiny. Constant vomiting leads the body to dehydration.

Fluid imbalance disrupts the balance of certain important chemicals (electrolytes) in the blood, which can cause complications such as irregular heartbeat and, if electrolyte balance is not restored, shock.

Renal failure is a dangerous complication that occurs due to severe dehydration and/or systemic infection due to compromised intestinal integrity.

Tests and procedures that are used to diagnose intestinal obstruction:

physical examination. The doctor will ask about your medical history and symptoms. He will also do a physical examination of the child to assess the situation. The doctor may suspect an intestinal obstruction if your baby's belly is swollen or tender, or if a lump is felt in the abdomen. The doctor will also listen to bowel sounds with a stethoscope;
. To confirm the diagnosis of intestinal obstruction, your doctor may recommend an abdominal x-ray. However, some obstructions in the intestines cannot be seen using standard X-rays;
CT scan(CT). A CT scan combines a series of X-ray images taken from different angles to produce cross-sectional images. These images are more detailed than standard X-rays and are more likely to show bowel obstruction;
ultrasonography. When intestinal obstruction occurs in children, ultrasound is often the test of choice;
air or barium enema. During the procedure, the doctor will inject liquid barium or air into the colon through the rectum. For intussusception in children, an air or barium enema may virtually eliminate the problem and no further treatment will be required.

Treatment of intestinal obstruction in children

Children with suspected intestinal obstruction will be hospitalized after an initial diagnostic examination. Treatment will begin immediately in order to avoid pinching of the intestinal loops, which can be fatal.

The first step in treatment is the insertion of a nasogastric tube to remove the contents of the stomach and intestines.
Intravenous fluids will be administered to prevent dehydration and correct any electrolyte ion imbalance that may have already occurred.
In some cases, it is possible to avoid surgery. Volvulus, for example, can be treated with a rectal tube inserted into the intestine.
In infants, a barium enema can treat intussusception in 50 to 90% of cases.
Another, newer contrast agent, gastrograph, can be used. It is believed to have therapeutic properties as well as the ability to improve bowel scans.
Sometimes an air enema is used instead of a barium or gastrograf enema. This manipulation successfully treats partial obstruction in many infants.

Children usually remain in the hospital for observation for two to three days after these procedures.

Surgical treatment is mandatory if other efforts fail to correct or eliminate the blockage.

Typically, complete obstruction requires surgery, but partial obstruction does not. Strangulated areas of the intestine require emergency surgery. The affected area is removed and part of the intestine is cut out (bowel resection).

If the obstruction is caused by a tumor, polyps, or scar tissue, they will be removed surgically. Hernias, if present, are repaired to correct the obstruction.

Antibiotics may be given before or after surgery to avoid the risk of infection at the site of the blockage. Fluids are replenished intravenously as needed.

Immediate (urgent) surgery is often the only way to correct intestinal obstruction. As an alternative treatment, a diet high in fiber may be recommended to stimulate proper stool formation.

However, ordinary constipation is not the cause of intestinal obstruction.

Forecast

Most types of intestinal obstruction can be corrected with timely treatment, and the affected child will recover without complications.

Uncontrolled intestinal obstruction can be fatal.

The intestines either become pinched or lose their integrity (perforate), causing massive infection of the body. The chance of recurrence is as high as 80% in those whose volvulus is treated with medication rather than surgery.

Recurrences in infants with intussusception usually occur within the first 36 hours after the blockage is cleared. The mortality rate for unsuccessfully treated children is 1 - 2%.

Most cases of intestinal obstruction cannot be prevented. Surgical removal of tumors or polyps in the intestine helps prevent relapses, although adhesions can form after surgery, becoming another cause of obstruction.

Preventing some types of intestinal problems that lead to intestinal obstruction involves ensuring a diet that includes enough fiber to promote normal stool formation and regular bowel movements.

Preventive nutrition includes:

foods high in coarse fiber (whole grain bread and cereals);
apples and other fresh fruits;
dried fruits, prunes;
fresh raw vegetables;
beans and lentils;
nuts and seeds.

Diagnosis of intestinal obstruction in a child depends on recognition of related symptoms.

It's important to remember that eating a healthy diet with plenty of fruits, vegetables, grains, and drinking enough water throughout the day will help keep your gut healthy.

Parents should be aware of the child's bowel habits and report cases of abdominal pain and vomiting to the pediatrician when this occurs.

There are many potential causes of intestinal obstruction. Often this disease cannot be prevented. Timely diagnosis and treatment are critical. Uncontrolled bowel obstruction can be fatal.