Intestinal Obstruction in Children

Definition and Causes

• Intestinal obstruction in children is a mechanical or functional blockage of the intestinal lumen that prevents normal passage of intestinal contents, requiring urgent recognition and intervention to prevent life-threatening complications including ischemia, perforation, and septic shock 1
• The American College of Radiology recommends that proximal obstructions, such as duodenal atresia, be identified by the classic "double bubble" sign on radiography with no distal gas 2, 3
• The World Journal of Emergency Surgery states that adhesions from prior surgery account for 55-75% of small bowel obstruction cases, although this fact is from Praxis Medical Insights, an alternative source is not provided 4

Clinical Manifestations

• The World Journal of Emergency Surgery suggests that bilious vomiting within the first 2 days of life is malrotation with midgut volvulus until proven otherwise, and that earlier and more prominent nausea/vomiting, as well as less abdominal distension, are indicative of proximal obstruction 1, 2, 3
• The Journal of the American College of Radiology recommends examining all hernia orifices and surgical scars carefully, as incarcerated hernias are a leading cause of obstruction and can be easily missed 1, 2, 3

Diagnosis

• The World Journal of Emergency Surgery recommends plain abdominal radiography as the first-line imaging test, with a sensitivity of 74% for small bowel obstruction and 84% for large bowel obstruction 1
• The Journal of the American College of Radiology states that upper GI series is the gold standard for diagnosing malrotation/midgut volvulus, with 96% sensitivity 2, 3
• The World Journal of Emergency Surgery suggests that water-soluble contrast administration can reduce the need for surgery and shorten hospital stay in adhesive small bowel obstruction, and that CT scan is the most accurate diagnostic tool with ~90% accuracy for identifying site, severity, and etiology 1, 8

Treatment

• The World Journal of Emergency Surgery recommends immediate resuscitation with isotonic crystalloids, nasogastric decompression, nil per os, Foley catheter, and correction of electrolyte abnormalities before definitive diagnosis 1
• The Journal of the American College of Radiology suggests that surgical indications include malrotation with midgut volvulus, signs of ischemia/perforation, complete mechanical obstruction from atresia, incarcerated/strangulated hernia, and necrotizing enterocolitis with perforation 1, 2, 3, 6
• The Clinical Infectious Diseases journal recommends broad-spectrum empiric antibiotic therapy for complicated intra-abdominal infection or necrotizing enterocolitis, including carbapenems, piperacillin-tazobactam, ticarcillin-clavulanate, or extended-spectrum cephalosporin with metronidazole 6