1. NEONATAL LOWER INTESTINAL OBSTRACTION

2. Lower GI Obstraction

3. Distal Obstruction

4. Signs of Intestinal Obstruction:
1- pain>colic 2-vomiting >depend on the level 3-distention> the distal the obstruction the more the distention 4-absolute constipation > early in large bowel & late in small bowel .

5. Hirchsprung’s Disease

6. Barium Enema

7. -common in males
-recto-sigmoid is most common
-s/s:failure to pass meconium in the 24h of life( imp)
,abdominal distention ,bilious vomiting
In older children> constipation
Dx: xray >dilated colon
PR> gush of stools
unprepared enema> retention of barium
Biopsy (gold one)
-Rx:- resuscitation
- pull through procedure ( can be done after colostomy)

8. Anorectal Malformation
Cutaneous fistula rectourethral fistula

9. Cutaneous fistula

10. recto-vistibular fistula

12. ARM( invertogram)
Invertogram
Cross table

13. ARM(rectal gas)

14. Distal Loopogram
Recto urethral Fistula

15. Colostomy PSARP

16. -It can be high or low type according to puborectalis -low> female > recto-vistibular fistula
-high> male> recto vasical
-associated with VACTERL
-s/s:no anus ,fistula, UTI, bowel obstruction.
-Dx: physical examination ( the imp)
cross table
invertogram
xray> for rectal gas US

17. Rx: Low type with fistula>>repair the fistula & anoplasty High type>>colostomy then anoplasty

18. X-Ray Muconium ileus

19. Muconium ileus

20. Muconium ileus

21. -solid muconium
15% of cyctic fibrosis
-s/s: bilious vomiting ,distention ,no passing of meconium
Dx: FHx of CF, Xray ( air fluid levels- soap bubble ) , enema ( microcolon)
-Rx: non-surgical>>>Gastrografin enema & pancreatic enzymes replacement
If not surgically by ( enterotomy )

22. Muconium Plug it is a major DDx of Hirchsprung’s Disease

23. Colonic Atresia