Congenital intestinal obstruction is a developmental anomaly that arises as a result of abnormal formation and fixation of the fetal intestinal tube, impaired intestinal innervation, as well as malformations of the mesentery. Very often, this condition is associated with other congenital anomalies, including congenital heart defects, esophageal malformations, and anorectal abnormalities.
Clinical manifestations of intestinal obstruction
In the clinical presentation of high intestinal obstruction in children, the most characteristic feature is repeated vomiting of ingested food (milk), which is typically green in color due to bile admixture. Stool is absent or acholic (uncolored).
Low intestinal obstruction is characterized by vomiting of ingested food with bile admixture and, after some time, with intestinal contents. There is absence of stool and progressive abdominal distension caused by gas accumulation within the intestines.
Such children are lethargic, show minimal response to examination, and exhibit abdominal tenderness on palpation of the anterior abdominal wall. In severe cases, the condition may be complicated by the development of peritonitis.
Diagnosis of prenatal intestinal obstruction
The diagnosis can be established antenatally during ultrasound examination of a pregnant woman. In most cases, the physician relies on indirect sonographic signs.
Congenital high intestinal obstruction is typically associated with polyhydramnios and enlargement of the fetal stomach and duodenum. In cases of low intestinal obstruction, dilation of intestinal loops is detected.
Postnatal diagnosis is based on clinical findings, including the onset of vomiting shortly after birth, absence of stool passage, and marked abdominal distension.
Plain abdominal radiography is mandatory for all newborns and infants with suspected congenital intestinal obstruction.
Treatment approach
In cases of high intestinal obstruction, once the underlying cause has been eliminated, a single-stage surgical approach is usually preferred. An anastomosis is created between segments of the duodenum and the small intestine without resorting to staged procedures.
In low intestinal obstruction, surgery is most often performed in two stages due to the frequent presence of peritonitis or the inability to immediately create a safe anastomosis. The first stage involves elimination of the cause of obstruction with creation of a stoma (externalization of a bowel segment) on the anterior abdominal wall. The second stage is performed several months later and includes closure of the stoma and formation of an anastomosis between the intestinal segments.
