A wide variety of anomalies are responsible for congenital intestinal obstruction in neonates. Artesia and stenosis at different levels of intestine, annular pancreas, malrotation of gut with its different spectrums, meconium diseases, Hirschsprung disease and Anorectal malformations of varied presentations are among the commonest etiologies. Congenital short left colon syndrome, bands and adhesions, Megacystis microcolon intestinal hypoperistalsis syndrome and others constitute the rarer causes of obstruction. However some kind of incomplete obstructions may not present acutely in the neonatal period, and may be brought to attention at an older age e.g. stenosis, membranes with central hole or malrotation.¹
Distinguishing features of different causes / level of an intestinal obstruction in newborns [emphases added]:
Bilious vomiting, abdominal distention, and failure to pass meconium or stool are the more prominent features of presentation in most cases. Of course the sequence of appearance of symptoms varies depending on the level of obstructed bowel. Bilious vomiting from the very outset or soon followed by a few episodes of non-bilious ones, should always be considered significant and surgical unless proved otherwise. Almost all term healthy neonates should pass meconium within first 24 hours of life; any delay in the passage of meconium beyond 24 hours should raise the suspicion of obstruction, if no co-morbid medical conditions like hypothyroidism or sepsis are suspected.¹
- vomiting – especially bilious
- sepsis
- CNS lesion
- necrotising enterocolitis
- abdominal distension and constipation
- below low small intestinal
- abdominal pain
- intermittent, colicky – poorly localised: visceral distension
- continuous – well localised: peritoneal irritation
- oesophageal atresia
- excessive secretions / foaming at the mouth
- ± coughing spells, cyanotic attacks (aspiration pneumonia)
- ± gastric distension
- pyloric stenosis
- otherwise well baby
- non-bilious vomiting at 4-8 weeks, becoming increasingly frequent and forceful
- ± slight haematemesis: bright red flecks or coffee-ground
- duodenal obstruction:
- duodenal atresia
- duodenal stenosis
- diaphragmatic hernia
- malrotation with bands or volvulus
- annular pancreas
- obstruction of jejunum / ileum:
- inguinal hernia – especially first 6 months of life
- intussusception (late)
- atresia / stenosis
- meconium ileus
- long segment Hirschsprung’s disease
- peritoneal bands / herniae
- duplication cysts
- large bowel obstruction:
- Hirschsprung’s disease
- anorectal anomalies
- necrotising enterocolitis
- adhesions, post-operative
complete obstruction: (e.g. atresia) symptoms soon after birth, but other lesions may not be symptomatic until infancy, childhood, or adulthood
intermittent partial obstruction: may present as failure to thrive
Reference
- Mitul AR. Congenital Neonatal Intestinal Obstruction. J Neonatal Surg. 2016 Oct 10;5(4):41. doi: 10.21699/jns.v5i4.472. PMID: 27896149; PMCID: PMC5117264.
