1. INTESTINAL OBSTRUCTION Presented by:- Amani aziz alrahman

2. Colon atresia
Meconium plug
Meconium ileus
Anorectal malformation
Small left colon syndrome
Megacystic-microcolon-intestinal hypoperstalsis syndrome

3. Neonatal intestinal obstruction
Symptoms:
Bilious vomiting
Abdominal distention
Delay in passing meconium
Sign:
Visible bowel loops
tender on palpation, bowel is palpable
Dull on percussion
Rectal examination

4. NPO Treatment : Investigation:
X-ray :distended intestinal bowel, multiple fluid level
Contrast enema: diagnostic
Rectal biopsy
Treatment :
NPO
Nasogastric tube
I.V fluids , antibiotics
Treat the cause

5. Colon atresia
Lest common one of the intestinal atresia , the common site is transverse colon
Ischemia in the vascularity of the mesentery necroses of the bowel segment
Polyhydraminos
Contrast enema is diagnostic obstruction site, and distal atrophy , proximal dilatation
Treatment resection of the dilated part and reanastomosis.

6. Meconium plug Mildest and the most common 1\500 to 1\1000
Etiology is not clear
No fluid on x-ray
Contrast :diagnostic
Treatment : rectal stimulation
Contrast
N.B: observe

7. Meconium ileus
30% of intestinal obstruction, usually present in the first days in life
50% associated with other intestinal problem (volvulus , atresia, perforation )
15% of patients with cystic fibrosis (AR)
P.R: small caliber of rectum, rectum is empty
X-ray: ground- glass appearance
Contrast enema: empty micro colon, entrapment of meconium in the ileum
50% present with complication (meconium peritonitis, perforation)

8. X-ray: intraperitonial calcification, free air or very large air_ fluid levels
Treatment : gastrograffin enema administration
Operative evacuation of the obstruction by irrigation

9. In case of complication laprotomy is required terminal ileum is opened wash out the meconium and temporary ileostomy may be required some time intestinal resection and anastomosis

10. Anorectal malformation
1\4000 to 1\8000
Defect in the embryological development Urorectal septum, lateral mesoderm structures and ectodermal structures from the normal rectum and lower urinary tract
Anal stenosis
20% of anarectal malformation, anal web
Anus appear very small, black dots of meconium
P.R: small , tight anus
Treatment: dilatation, may be need to continued for several months

11. Anal atresia
Male = female
Perineal inspection reveals
Absent of anus
It is divided into high or low
Depending on whether the rectum ends above the levator muscle or partially descends through the muscle
Low type: rectum ends above the skin
In male ::rectocutaneous fistula ,with normal control of faeces

12. In female: the anus open in front of it’s normal position (vestibular anus)
High type: rectum ends before levator ani muscle, with no feacal control
In male: rectourethral fistula
In female: rectovaginal fistula
TREATMENT
Low type: anoplasty , good prognosis
High type: Colostomy at birth, then at 6 months posterior sagittal anorectoplasty, 2 months later close the colostomy

13. Investigation: (invertogram)
measure the distant between radioopuqe at anal site and the rectum
Draw line from the coccyx to the syumphs pubic (levator muscle)
N.B:70% present with associated anomalies 50% urologic, 20% VACTERL

14. Small left colon syndrome
Rare cause
History of maternal diabetes with abnormal glucose tolerance test in 50%
infants how are hypoglycemic
septic
an association with hypothyroidism, hypermagnesaemia
Ass/e maternal use of psychotic medication
Dysmotility in the descending colon

15. Contrast study : short colon and lack of tortuosity from the splenic flexure to the anus
Rectal biopsy shows present of ganglion cells
If it sever it required colostomy

16. Megacystic-microcolon-intestinal hypoperistalsis syndrome
Rare cause
Megacystic-microcolon-intestinal hypoperistalsis syndrome
There is a high number of ganglion cells
Megacystis and megaureters
Most of the patients die from the complication
Contrast enema:

17. THANK YOU