Intestinal obstruction and ileus is not something unique to children. An intestinal obstruction can occur mechanically due to a mechanical obstruction (such as tumour, adhesions, herniation) that prevents the passage through the bowel. A functional obstruction (or ileus) is when there is nothing blocking the bolus but there is a disruption in the peristaltic contractions leading to slow or absent movements of the intestines (often the small intestine).
Causes of intestinal obstruction and ileus in children
- Intestinal obstruction
- Meconium ileus - not passing stool within the first 48 hours of life.
- Hirschprung’s disease
- Small bowel or colonic atresia
- Intussusception
- Imperforate anus
- Intestinal malrotation with volvulus
- Strangulated hernia
- Ileus
- Gastroenteritis
- Chemical and electrolyte imbalance
- Abdominal surgery
- Ischaemia
- Appendicitis
- Kidney or lung disease
- Drugs
😷 Presentation
- Failure to pass stools or wind (absolute constipation)
- Abdominal pain
- Distension
- Vomiting - may be billions (containing bright green bile)
- Abnormal bowel sounds - high pitched and tinkling sounds initially and then absent bowel sounds in later presentations.
🔍 Investigations
🥇 Abdominal X-ray - this is the first-line investigation. It would show:
- Dilation of the loops proximal to the obstruction
- Collapse of the loops distal to the obstruction
- No gas in the rectum
🏆 CT is the gold-standard for small bowel obstruction especially.
🧰 Management
In children, intestinal obstruction is a paediatric emergency. It requires urgent surgical intervention.
- Initial mangement
- Make the child nil-by-mouth.
- Place a nasogastric tube and give IV fluids (drip and suck).
- Definitive managment involves surgical intervention to relieve the obstruction and fix the underlying cause.
For a paralytic ileus, one simply must identify and reverse the underlying cause.