Symptoms of intestinal obstruction in children. Symptoms of intestinal obstruction, treatment. Intestinal obstruction in children: symptoms Intestinal obstruction symptoms in a 1 year old child

If there is a slowdown in the process of fecal excretion or its complete cessation, doctors say that intestinal obstruction in children has been diagnosed. The disease is complex and multi-causal. Violation cause birth defects development of the intestinal region, motor dysfunction of the organ, growing tumors. The pathology requires immediate medical intervention, since there is a high risk of developing severe consequences, including the death of the child or newborn. The disease is treated with medication, diet therapy, and surgery.

Description of the pathology

Intestinal obstruction in children is a pathology associated with a failure in the process of pushing chyme (broken down food with digestive juice) through the lumen. In babies of the first year of life, the disease is accompanied by severe pain, cramps, and vomiting. Most people use surgical tactics to eliminate pathology, especially in newborns. Older children are prescribed conservative treatment and diet.

In infants, the disease causes severe cramping pain.

Children's intestinal obstruction is a kind of blockage of the lumen. The complexity and severity of the disease depends on the location of the problem - the higher the blockage occurs, the more severe the disease will be. The peculiarity is the manifestation of specifically rapid symptoms in a vivid form. Correct and timely response in the form of treatment determines the outcome. If chronic form eliminated with medication, then acute - only surgically.

Classification of intestinal obstruction in children

Intestinal obstruction in newborns and older patients is classified according to genetics, anatomical-physiological, and symptomatic parameters. Correct definition the type of blockage allows you to prescribe adequate treatment and adjust the intensity of the measures taken. International classification:

1. Based on origin, a distinction is made between congenital and acquired forms.
2. According to the mechanism of formation - mechanical, dynamic.
3. According to the characteristics of symptoms - complete, partial, acute, chronic.
4. According to the nature of compression of the vessels supplying the intestine with blood - strangulation, obstruction, mixed (with adhesions).

Congenital

The formation of intestinal obstruction can begin in the womb.

This form of intestinal obstruction is formed in the womb against the background of fetal development anomalies, so the newborn suffers from the first hours severe symptoms dysfunction. When the disease is particularly severe, the baby develops vomiting of bile and bloating. In mild forms of the disease, constipation and vomiting are observed. If this pathology is detected late, the risk of intestinal rupture increases. Manifestations congenital pathology are stenosis (narrowing of blood vessels, lumen), atresia (fusion of organ walls), inflammation. This form is typical for newborns.

Acquired

Pathology is provoked by external or internal unfavorable factors. It most often develops in infants aged from 4 months to a year in the form of intussusception (penetration of one part of the intestine from another) or a mechanical disorder. Adhesions are formed quite rarely. Characteristic Features the disease is unexpected, paroxysmal pain syndrome, which turns into vomiting, and blood and mucus are found in the stool. A childhood illness requires immediate hospitalization of the baby.

The main cause of obstruction is stagnation feces against the background of weakness (atony) of the intestinal muscles, and, consequently, peristalsis.

Dynamic

Jumps in intestinal pressure provoke peritonitis.

The development of this form is provoked by weakening of the regional blood supply to the mesentery, disruption of water and electrolyte balance, and dysfunction of the central nervous system departments responsible for correcting the functioning of the gastrointestinal tract. As a result, inflammation develops. The incidence is 10% of all recorded cases. Classification into subforms:

• paralytic, when the problem of atony arises against the background of the operation and is accompanied by paresis, a jump in intraintestinal pressure, which is fraught with intestinal rupture and peritonitis;
• spastic pathologies, characterized by excessive muscle tension, paroxysmal abdominal pain, absence of a jump in temperature, bloating, but vomiting is possible.

Mechanical

This pathology can be caused by the formation of adhesions in the body against the background of improper wound healing after intervention in the abdominal cavity. Depending on the causal factors There are such subforms:

Intestinal obstruction in newborns and older children develops in 3 stages:

1. First, initial stage lasts 3-12 hours. Characteristic symptoms are abdominal pain, strong rumbling, flatulence.
2. The intermediate stage is 13-36 hours. During this period, the baby shows signs of imaginary improvement, which characterizes the beginning of intoxication of the body with partial loss of fluid.
3. The last, terminal stage overtakes the baby with a sharp increase in symptoms and damage to other organs.

Causes

Common provocateurs for the development of childhood intestinal obstruction are the following disorders and conditions:

Each of the listed types intestinal obstruction differs between infants and older children characteristic symptoms, but there are general signs pathologies such as:

Revealing

If you notice the first symptoms of the disease in a child, you should immediately seek medical help, because in case acute course Late diagnosis is fraught with complications including the death of the baby.

The diagnostic tactics used by the doctor are as follows:

1. Questioning, examination, palpation of the child’s abdomen - to identify the clinical picture.
2. X-ray examination. It can be carried out with barium contrast, air injection - to determine the places of narrowing, fusion, shortening or lengthening of the sigma.
3. Laparoscopy. Used in emergency cases - intestinal volvulus, adhesive obstruction.
4. Ultrasound is an auxiliary examination method.

Intestinal obstruction in children can be congenital or acquired.

Congenital intestinal obstruction is associated with intestinal malformations (atresia, etc.). The clinical picture depends on the level of obstruction. With high intestinal obstruction, immediately or shortly after birth, persistent obstruction appears with an admixture of bile in the vomit. Stool is absent or retained. In the epigastric (epigastric) region there is swelling that disappears after vomiting. With low congenital intestinal obstruction, the leading symptom is stool retention. Vomiting occurs later - on the 2-3rd day of life, the stomach is swollen, peristalsis is increased. With delayed diagnosis, perforation () of the intestine may occur with subsequent development.

Among various forms of acquired intestinal obstruction in children, intussusception is in first place in frequency. It develops almost exclusively in infants, most often at the age of 4 months. up to 1 year. The disease begins suddenly with attacks of anxiety and motor agitation (due to pain), followed by light intervals. Vomiting soon appears. The temperature remains normal, there may be one or two stools mixed with blood or blood with mucus. When examined during a lull period, the abdomen is soft; upon digital examination, blood is usually detected through the finger.

Acquired intestinal obstruction in children may be associated with fecal stagnation (coprostasis) with sluggish intestinal function, some (see Megacolon, Cystic fibrosis) or with blockage of the intestine by worms in ascariasis. In these cases, intestinal obstruction often occurs as a partial one.

Adhesive intestinal obstruction in children is less common; its course is not much different from adhesive intestinal obstruction in adults.

Dynamic intestinal obstruction in children is most often caused by intestinal paresis and occurs when inflammatory processes in other organs (especially in infants), as well as in peritonitis and toxic conditions of various origins. Clinical manifestations less pronounced than with mechanical intestinal obstruction. There is stool retention, bloating, a sharp weakening or absence of peristalsis, and often vomiting. Children are restless. Decisive in diagnosis is.

In case of intestinal obstruction in children, it depends on the timing of the start of treatment and surgical intervention. The prognosis is especially serious in advanced cases. In this regard, early hospitalization is critical.

Treatment. All children with suspected intestinal obstruction are subject to emergency hospitalization. Conservative treatment is permissible only for dynamic intestinal obstruction: enemas with a hypertonic solution, gastric lavage, subcutaneous hypertonic solutions intravenously. For coprostasis and intestinal obstruction caused by worms, treatment begins with cleansing and siphon enemas with a 1% sodium chloride solution. If these measures are ineffective, surgery is required.

In case of intussusception within 24 hours from the moment of illness, conservative straightening of the intussusception is indicated by introducing air into the rectum (under x-ray control).

In more late dates, and if conservative treatment is ineffective, urgent surgery is indicated.

For all other types of intestinal obstruction (congenital, adhesive, etc.), emergency surgical intervention is indicated (dissection, straightening of a volvulus, a section of intestine, etc.).

Intestinal obstruction in children is a condition that occurs as a result of impaired movement gastrointestinal tract its contents.

Types and causes of intestinal obstruction

Since pathology is provoked by various reasons (anatomical, genetic, etc.) and has different clinical picture, the treatment of this pathology depends on its type.

By origin, intestinal obstruction is divided into:

• Congenital. This form includes intestinal obstruction, which is caused by genetically determined pathologies and malformations of organs. abdominal cavity– cystic fibrosis, Hirschsprung’s disease, stenosis (pathological narrowing) of the intestine or the absence of an organ lumen in a certain area (atresia), the presence of enterocystoma, ring-shaped pancreas, Ladd’s syndrome.
• Acquired. Formed as a result of the appearance in the intestines of a mechanical barrier that is disrupted motor function organ walls.

Focusing on the mechanism of development of obstruction and its causes, the following are distinguished:

• Dynamic type - occurs in the absence of mechanical obstacles due to impaired motor function. Intestinal obstruction of this type is divided into paralytic (caused by a decrease in the tone of myocytes - the cells of the muscular lining of the intestinal wall) and spastic (associated with an increase in the tone of intestinal myocytes). Accounts for 8-11% of all cases. More often there is a paralytic form, which is provoked by hypokalemia and injuries to the abdominal area. Peritonitis and operations affecting organs located in the abdominal cavity also affect.
• Mechanical type - obstruction is associated with partial or complete closure of the intestinal lumen. This form can be strangulation (invagination, intestinal volvulus occurs, a hernia is strangulated, or organ nodulation occurs due to the mesentery being too long) or obstructive (occurs due to the appearance of a mechanical obstacle to the movement of intestinal contents).

The strangulation type of obstruction is caused by a congenital pathology of the mesentery, often causing volvulus small intestine, as well as the presence of adhesions (connective tissue cords formed between the peritoneum and the organs located in it as a result of abdominal injuries and bruises after surgery).

In children, the obstructive type is detected quite rarely (10%). It develops due to the presence of kinks, adhesions, scar-shaped narrowings, compression of the intestine from the outside by various neoplasms, blocking of the lumen by a foreign body, a ball of roundworms, and fecal stones.

In the case of a combination of blockage and infringement, pathology is detected mixed type, developing with:

• Intussusception, which occurs due to the penetration of part of the intestine into the lumen of its second part. In 85-90% of infants, intussusception is the cause of the disease (intussusception is most often observed in the period from 4 to 9 months). After a year, intussusception is a rare occurrence; it is provoked by the presence of Meckel’s diverticulum and various neoplasms.
• The formation of adhesions in the abdominal cavity, which compress the intestines.

Intestinal obstruction in children according to the form of its course is divided into:

• Acute – symptoms occur unexpectedly.
• Chronic - intestinal blockage in children develops gradually (usually due to an adhesive process that occurs after surgery in the abdominal cavity, after penetrating abdominal wounds or due to a slowly growing tumor). Signs do not appear for some time; with the adhesive type of pathology, the condition can stabilize for a long period of time.

Chronic pathology can suddenly turn into an acute form if a cord or scar has formed.

Depending on the location of intestinal obstruction, there are:

• High intestinal obstruction, if the disorder is located in the area of ​​the small intestine after the ligament of Treitz to the bauginian valve;
• Low if the disorder is localized below the bauginian valve.

Intestinal obstruction in children, depending on the ability of the gastrointestinal tract contents to move, can be complete or partial.

Most often, the disease in children is associated with intussusception; the second most common cause of intestinal obstruction is coprostasis (stagnation of feces) in combination with sluggish bowel function, then malformations (enlarged colon (megacolon) or cystic fibrosis) and ascariasis. Typically, these types of diseases are related to partial obstruction intestines.

Intussusception is provoked by changes in intestinal motility. The disease is a consequence of increased mobility of the colon and the specific structure connective tissue in children of the first year of life, inflammation in the intestinal wall, mechanical obstruction. Violation of peristalsis entails retraction of the contracted section of the intestine and its mesentery into distal section with normal clearance. In this way, an internal cylinder (intussusception) is formed, then swelling begins and the blood supply to the intestine is disrupted; in the absence of timely treatment, necrosis of part of the intestine develops.

Disorders due to intussusception can also occur as a result of changes in the baby’s diet or the introduction of complementary foods.

Dynamic type disease in children is usually associated with intestinal paresis, which develops as a result inflammatory diseases(pneumonia, etc.) and toxic conditions.

IN childhood adhesive obstruction is rare.

Symptoms of pathology in newborns

Intestinal obstruction in newborns may appear a couple of days or hours after birth.

The cause of congenital pathology is one of the developmental defects. Since certain defects are formed at an early stage intrauterine development, intestinal obstruction in children develops before birth, and symptoms are observed from the first hours of life.

If the developmental defect is associated with an abnormal arrangement of organs, a chronic disease or strangulating acute intestinal obstruction develops.

The main early symptom of the disease in newborns is vomiting. Since the signs of a congenital anomaly are varied, the nature of vomiting, the type of pain and feces help determine the level of location of the pathology.

You should also pay attention to:

• time of vomiting;
• intensity of vomiting;
• the nature of the vomit;
• connection of this symptom with the feeding process.

Vomiting in a child with obstruction located:

• in area upper third esophagus and pharynx accompanied increased salivation(hypersalivation);
• above the papilla of Vater is cheesy in nature or the vomit is a milky mixture containing mucus;
• below the papilla of Vater includes bile;
• in the area of ​​the pylorus contains curdled milk or formula for feeding without mucus;
• in the area of ​​the jejunum, ileum or colon contains chyme (partially digested food, gastric and intestinal juice, gland secretions, bile), fecal vomiting is possible.

Since in case of complete intestinal obstruction due to the intrauterine formation of a paralytic obstruction of the small intestine (ileus), normally formed meconium does not pass, it is not always possible to determine the nature of the stool.

The clinical picture of the disease includes:

• passage of small amounts of meconium (observed with stenosis);
• the release of meconium and transitional stool during volvulus until the 4-5th day of life, then blood impurities appear in the scanty stool, and at the next stage of the development of the disease its release stops.

The baby is suffering from abdominal pain - the child is restless, crying and kicking his legs. Paroxysmal pain is a sign of strangulation obstruction (provoked by an anomaly of intestinal rotation or volvulus). Abdominal pain that intensifies during palpation indicates low atresia (the cause of pain is increased stretching of the intestinal loops).

The child also shows signs of dehydration and intoxication (these symptoms appear earlier in time with low-type obstruction).

With high obstruction, due to distension of the stomach, bulging is observed in the epigastric region, but the intestine is not contoured, and with low obstruction, there is significant bloating and stretched intestinal loops are visible. In a child with meconium ileus, loops filled with viscous meconium (may resemble a rosary) are palpable.

In case of obstruction caused by intussusception, blood is present in the baby's stool before stool retention (the stool resembles “raspberry jelly”).

At congenital disease applies only surgery. The preparation time for surgery depends on the type of disease, the presence of concomitant defects, birth trauma, general condition of the child.

If children have symptoms of intestinal perforation or the cause of the obstruction is considered to be acute Ladd syndrome, doctors should prepare for emergency surgical treatment. In other cases, preparation for surgery takes from 2 to 12 hours (the period depends on what other diseases are present and how severe the disturbance of homeostasis is).

Symptoms of intestinal obstruction in children

Intestinal obstruction in children of any origin is always manifested by abdominal pain, increased peristalsis and flatulence. Acute illness begins suddenly, the course of the disease can be divided into three stages:

• The initial stage of the disease lasts from 3 to 12 hours (the “ileus cry” stage). At this stage, the child suffers from pain not associated with eating, increased peristalsis occurs, flatulence, bloating and stool retention occur. Depending on the type of illness, sooner or later the child develops repeated vomiting, a reflex initial stage diseases and caused by intoxication in the future. The pain is paroxysmal in nature with obturation (there are “light” periods when the child can even play), and with strangulation they are constant, but the intensity of pain can change.
• The second stage of the disease (intoxication stage) takes from 13 to 36 hours. Pain at this stage in any form of pathology is constant, there is bloating, frequent profuse vomiting, and lack of stool. Due to the inability to drink fluid and the disruption of its absorption in the intestines, dehydration rapidly develops in children at this time.
• At the third stage, a systemic disruption of the body’s functioning occurs. At this time, the child’s temperature and breathing rate increase (the cause is intoxication), and urine production stops. Symptoms of the disease include signs of peritonitis, severe acid-base balance, sepsis may develop.

Vomiting during intussusception initially includes the contents of the stomach, and after some time it becomes fecaloid (feces).

Doctors should be informed about the timing of the onset of vomiting - the earlier it appears, the higher the site of obstruction is located.

Acute pathology in children is not always accompanied by flatulence and lack of stool - these signs are more often present in low obstruction and may be absent in the upper form of this disease. In all cases, there is a decrease in peristalsis and, with the development of peritonitis, a stop in the passage of feces.

If the child does not appear timely treatment, the condition progressively worsens, tachycardia and temperature increase (in case of sepsis - to extremely high numbers).

In such cases, urgent surgical treatment is necessary - without surgery, multiple organ failure develops and the patient dies.

The chronic form of the disease in children is relatively rare, since the cause is slow-growing tumors and adhesions that occur after surgery or injury. The disease in this form is characterized by periodic constipation, accompanied by flatulence, which is followed by periods of diarrhea (stool has a putrid odor). The child may complain to parents and doctors about stomach rumbling, bloating, and cramping pain. As the intestinal lumen gradually narrows, the attacks intensify; with bloating, the intestinal loops begin to become contoured (with a thinned abdominal wall).

After the formation of a cord or scar from adhesions, the chronic form of the disease without treatment becomes acute.

In all cases, when specified symptoms You should urgently seek help from doctors - the child must be hospitalized. Treatment is carried out only in the hospital. In cases of timely seeking help for intussusception (at the first stage), conservative treatment is possible - air is supplied to the intestines using a special device and, with X-ray control, they try to straighten the intussusception.

Conservative treatment is also carried out in the absence of obvious mechanical obstruction. Treatment includes novocaine blockade according to Vishnevsky, sodium chloride solution intravenously and atropine sulfate solution or proserin solution subcutaneously. If such treatment is ineffective, emergency surgery is performed.

If help was sought later than 12 hours (at the second stage) or the cause of obstruction was congenital anomalies or an obstacle of mechanical origin, surgical treatment should be performed immediately.

If peritonitis develops, it should be complex treatment.

Since intestinal obstruction cannot treat the patient outside the hospital, and this condition threatens the lives of children, in case of unexpected abdominal pain, vomiting and constipation, it is necessary to urgently seek help from a doctor.

All parents are certainly familiar with the phenomenon of abdominal pain in a child. Most often, these pains in babies are associated with intestinal spasms and quickly pass spontaneously or with a light massage (stroking) of the abdomen. However, you should not be careless about your child’s illness and think: “It will go away on its own!” Sometimes abdominal pain is a symptom of such a serious disease as intestinal obstruction.

Acute intestinal obstruction is understood as a violation or complete cessation of the movement of the contents of the digestive tract through the intestines.

Classification

The cause of intestinal obstruction may be intussusception.

Intestinal obstruction can develop in a child of any age, including a newborn.

Intestinal obstruction can be:

• congenital and acquired;
• high and low;
• full and partial;
• obstructive (due to the closure of the intestinal lumen by any formation);
• strangulation (due to compression of a section of the intestine);
• dynamic.

Causes of intestinal obstruction

The causes of intestinal obstruction in children can be:

• congenital pathology of the digestive canal;
• volvulus;
• intussusception (invasion of one part of the intestine into another with closure of the lumen);
• adhesions in the abdominal cavity;
• in the abdominal cavity and intestines;
• coprostasis (accumulation of feces in the intestines);

Congenital intestinal obstruction associated with malformations of the digestive tract: elongation of a section of the intestine (usually the long sigmoid colon) or narrowing of its lumen.

One of the variants of congenital narrowing of the lumen is pyloric stenosis: narrowing of the sphincter at the border of the stomach and intestines. Pyloric stenosis makes it difficult for milk to enter the intestines and already in the first 2 weeks of the baby’s life it manifests itself in profuse vomiting in the form of a fountain.

In infants, the causes of obstruction may include individual atypical location of the intestine or torsion of its loops.

In newborns, another form of intestinal obstruction may occur: meconium ileus . He is an option obstructive obstruction: the intestinal lumen is blocked by meconium, high-viscosity feces of a newborn.

Coprostasis, or the accumulation of feces in the intestinal lumen, can lead to obstructive intestinal obstruction in older children. The cause of coprostasis is a decrease in the tone of the intestinal wall and impaired peristalsis. It can also be noted when birth defect: elongated sigmoid colon. Coprostasis can block the lumen of the end portion of the small intestine or large intestine.

In infants and newborns, this functional inferiority of the digestive tract can occur after birth trauma, against the background, after surgery on the abdominal and chest cavity, at intestinal infections. At older ages, it often develops in severe illnesses due to toxic effects (for example, sepsis) and in the postoperative period.

Depending on the severity, obstruction can be complete or partial. At partial obstruction, the intestinal lumen is narrowed, but not completely blocked (for example, with dynamic obstruction) or blocked by some obstacle, but not yet completely. The intestine remains partially permeable to intestinal contents.

In addition, there are high obstruction (occurs in small intestine) And low(the large intestine is obstructed).

Symptoms

The clinical manifestations of the disease are different:

• Expressed – this is the constant and most early symptom. At first they are cramp-like in nature and recur every 10 minutes. The pain occurs suddenly, sometimes at night, and has no clear localization.

Repeated attacks of pain are associated with intestinal peristalsis, which is still trying to push through the contents. Then the muscles of the intestinal wall become depleted, the process enters the stage of decompensation, and the pain is constant. The pain subsides after 2-3 days, but this is a poor prognostic sign.

• - Same early sign with low obstruction. With high obstruction at the beginning of the disease, stool may appear, sometimes even multiple times: the bowel located below the obstructed area is emptied.

With meconium ileus, there is no stool after the baby is born.

May be present in the stool bloody issues, characteristic of intussusception. In these cases, it is necessary to differentiate obstruction from.

In case of partial obstruction, there may also be loose stool with an unpleasant putrid odor.

• Gas retention, bloating. In this case, asymmetric bloating is characteristic: the intestine is swollen above the level of obstruction. Sometimes the swollen intestine is felt by the doctor when palpating the abdomen and is even visible to the eye.

• Repeated vomiting is also characteristic of obstruction. Sometimes it is preceded by . The earlier vomiting appears, the higher the area of ​​obstruction is. At first, vomiting is a reflex in nature due to a process in the intestines, and then it becomes a manifestation of intoxication of the body.

With pyloric stenosis, vomiting is first observed approximately 15 minutes after feeding the baby, and then the time interval between feeding and vomiting increases due to the expansion of the stomach. Moreover, the volume of vomit is greater than the volume of milk drunk (fountain vomiting). Dehydration and weight loss develop.

The child becomes restless, cries, has a pained facial expression, increased sweating, and pallor of the skin.

Diagnostics

X-ray examination helps the doctor make the correct diagnosis.

1. Interviewing the child (if possible by age) and parents: allows you to find out the time of onset of the disease, complaints, dynamics of the disease, individual characteristics the child's body.
2. The inspection provides an opportunity to evaluate general state child, identify abdominal pain and its location, bloating, the nature of vomit and stool (if any), tension in the abdominal muscles, the state of the cardiovascular and respiratory systems and etc.
3. X-ray examination can be used to early diagnosis intussusception, confirm the presence of pyloric stenosis, lengthening sigmoid colon etc. According to the doctor's decision, in some cases air is pumped into the intestines through the rectum, and in some studies barium is used.
4. In cases that are difficult to diagnose, laparoscopy is used (for adhesive obstruction, torsion, etc.).
5. Ultrasound of the abdominal organs is used as an auxiliary examination method.

Treatment

If a child experiences abdominal pain, an urgent consultation with a surgeon is necessary! Attempts at self-medication are fraught with serious consequences due to lost time and late treatment.

At the slightest suspicion of intestinal obstruction, the child is hospitalized.

Treatment of obstruction can be conservative and surgical.

The choice of treatment method depends on the timing of treatment medical care and forms of obstruction. So, in case of congenital obstruction, with pyloric stenosis, with meconium ileus, surgical treatment .

Surgical treatment is also carried out for adhesive, the most severe and dangerous obstruction. In especially severe cases, it is sometimes necessary to remove the intestine to the anterior abdominal wall.

If you seek help late and necrosis (death) of the intestine develops, the affected area of ​​the intestine is removed during surgery. In case of development of peritonitis, complex treatment is carried out, including antibacterial drugs, detoxification therapy, painkillers and vitamins, and symptomatic treatment.

If you consult a doctor early about intussusception (no later than 12 hours from the onset of the first symptoms), conservative treatment . Using a special device, they pump air into the intestines and try to straighten the intussusception under the control of an X-ray machine.

To make sure that complete straightening of the intestine has occurred, the child remains under the supervision of a doctor in the hospital. Excess air from the intestines escapes through gas outlet pipe inserted into the rectum. A control X-ray examination is carried out using a barium suspension. If the intussusception is straightened, then after about 3 hours the barium enters the primary department colon and is later excreted in the feces.

The problem can be eliminated with surgery, but sometimes it is effective conservative therapy. The higher the blockage occurs, the more difficult treatment. The prognosis depends on the timeliness of diagnosis.

Kinds

Intestinal obstruction in children can be congenital or acquired. In the first case, symptoms appear in the newborn a short time after birth. The course of the disease depends on the degree of blockage.

If intestinal obstruction in a baby is not diagnosed in time, this can lead to intestinal rupture and peritonitis.

The acquired form is most often diagnosed in infants aged 4 months to one year.

Classification depending on the mechanism of formation:

• Dynamic. Occurs when intestinal motility is disrupted and mesenteric circulation slows down. It can be spastic (with prolonged intestinal tension) and paralytic (with relaxation of the intestine).
• Mechanical. Occurs when there is a physical blockage of the intestines, e.g. foreign body, worms, tumor.

According to the degree of obstruction:

• Full. Poses a threat to the child's life. The baby cannot have a bowel movement and emergency surgery is required.
• Partial. The intestinal lumen is not completely closed.

According to the level of intestinal involvement:

• Low. The blockage occurs in the small intestine, ileum, or colon.
• High. Occurs when the duodenum narrows.

According to the nature of the flow:

• Spicy. This form is characterized by pronounced symptoms.
• Chronic. This form develops with high obstruction. Symptoms increase slowly, pain is minor.

Causes

Causes of congenital intestinal obstruction in a child:

• malformations of the intestine during the embryonic period;
• pathologies of other gastrointestinal organs.

The blockage is formed at the stage of intrauterine development.

Causes of acquired intestinal obstruction in a child:

• poor circulation in the intestine;
• stagnation of feces in infants (meconium ileus);
• formation of adhesions in the intestines;
• blockage of the intestine by a tumor, foreign body, helminths, lump of food;
• intestinal diverticula;
• hernias in the abdominal cavity;
• twisting or bending of the intestines;
• intussusception (a condition in which the intestines fold in on themselves);
• overeating due to prolonged fasting;
• impaired peristalsis due to immaturity of the gastrointestinal tract;
• complication after surgery on the abdominal organs;
• long-term use of medications.

Symptoms

Symptoms of intestinal obstruction depend on the nature of the course and the degree of blockage. For acute form The following symptoms are typical:

• the child feels severe pain in the abdominal area, which can last from 2 to 12 hours;
• after painful sensations subside a little, signs of gastrointestinal dysfunction appear (bloating, flatulence, constipation);
• after a day, the pain becomes unbearable, and the child’s condition worsens.

With chronic intestinal obstruction, cramping pain appears after eating. Babies are bothered by constipation and frequent vomiting.

In children under one year old

Infants are not able to describe their complaints, so parents need to carefully monitor the baby’s condition.

Symptoms of intestinal obstruction in infants:

• Arises sharp pain and abdominal cramp. The child cries and clenches his legs. He cannot sit still, he tries to take a position in which the painful sensations. After a while, the baby suddenly stops crying. The attacks may recur after 15-30 minutes.
• Stool mixed with blood and mucus. Evacuation occurs after crying.
• Lack of appetite.
• Vomiting after an attack. Vomit may be mixed with bile.
• Bloating and lack of stool (with complete blockage of the intestine). Partial blockage may result in diarrhea.

If treatment is not sought immediately, newborns may develop a fever.

In children after one year

The manifestations are:

• attacks of cramping pain;
• lack of appetite;
• nausea and regular vomiting;
• stool retention, problems with bowel movements.

With excessive vomiting, symptoms of dehydration occur.

Which doctor treats intestinal obstruction in children?

It is necessary to contact a pediatric gastroenterologist and surgeon.

Diagnostics

The diagnosis of “intestinal obstruction” in children is made on the basis of the following examination:

• Examination of the child. The doctor palpates the abdomen. During palpation, swelling and pain are detected. A lump may be felt in the abdomen.
• X-ray of the abdominal cavity.
• Ultrasound. Is over informative method diagnostics rather than x-rays.
• Air or barium enema. Air or barium is injected into the rectum. With intussusception, this technique is not only diagnostic, but also treatment.

Treatment

Intestinal obstruction in newborns is best treated in the surgical department.

Before the baby is given an accurate diagnosis, there is no need to do an enema, give a laxative or rinse the stomach.

Treatment is carried out only after full examination. It can be conservative or operative.

In the absence of complications, therapy consists of eliminating the symptoms of intoxication and removing intestinal blockage. The set of events looks like this:

• To stop an infant from vomiting nasal cavity a probe is inserted to remove stagnation upper sections digestive tract.
• With severe peristalsis, the baby is given antispasmodics.
• Painkillers and antiemetics are prescribed.
• To restore the water-salt balance, solutions are administered intravenously.
• In case of intussusception, an air enema is given during the day. This procedure allows you to get rid of intestinal obstruction in newborns in 50-90% of cases.
• A rectal tube can help treat volvulus.

In case of complete obstruction, surgery cannot be avoided. A bowel resection is performed (the affected area is removed).

Prevention

In most cases, it is impossible to prevent intestinal obstruction. The only preventive measure is proper nutrition. Must be included in baby's diet dairy products, fresh fruits and vegetables, prunes and dishes with high content fiber.

The prognosis is favorable if help is provided to the baby in a timely manner. If not diagnosed in a timely manner, intestinal obstruction can cause infection and death of the baby.

Useful video about acute intestinal obstruction