The baby has intestinal obstruction. How to treat intestinal obstruction in newborns. Acquired and congenital obstruction

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Every mother knows what colic in the belly of a newborn baby is. Sometimes the painful condition of the crumbs tires the parents and leads to despair. Many people think that this is not a deviation from the norm - everyone goes through it Small child... You just need to be patient, the baby will grow up and everything will soon pass. But in fact, you need to take a closer look at the baby, because very often, under the usual colic in the abdomen, serious diseases can be hidden. One of these ailments is intestinal obstruction.

This is a type of pathology, as a result of which the process of moving the eaten food into the digestive tract occurs incorrectly. In children, the disease is most often congenital and in 25% of cases it is formed at the stage of intrauterine development.

The reason for the development intestinal obstruction is the malformation of the digestive system. For example, lengthening of a certain part of the intestine or narrowing of its lumen (stenosis), abnormal narrowing, overgrowth or absence of natural channels and holes in the body. In this case, the pathology is defined as "atresia". We can say that one disease provokes another. We will talk in more detail about intestinal obstruction in newborns further.

Causes of intestinal obstruction in newborns

Pyloric stenosis- is a narrowing of one of the parts of the stomach. With this pathology, the flow of food, namely milk, into the baby's stomach is disrupted, as evidenced by profuse regurgitation after eating, in the form of fountain-like vomiting.
Defects neighboring bodies, for example, the pancreas.
Tumor, formed in the intestinal lumen, provokes the formation and development of the so-called obstructive obstruction.
Helminths cause both forms of obstruction: partial and complete. The presence of helminths in the body leads to the release of toxins, which causes pain of varying intensity.
Postponed operation. Indication for surgical intervention is an adhesive process in the same section of the abdominal cavity. This rarely happens in newborns, more often in older children.
Intussusception. Faced with her, both newborns and older children infancy... This concept should be understood as a pathology in which part of one intestine grows into another. Statistics show that the disorder is more common among boys. It should be noted that more often intussusception occurs in children under one year of age.
Irregular peristalsis in the intestinal organs in young children. This is due to low levels of potassium in the blood. Doctors call the phenomenon "dynamic obstruction".
Coprostasis - this concept implies congestion feces in the intestines.

There are a lot of causes of pathology, and it can be difficult for doctors to determine what provoked it. As already mentioned, most often in newborn children, intestinal obstruction is found congenital. But there are times when a certain trauma leads to this disease (during childbirth, during surgery, or transferred intestinal infections). That is why parents should be especially attentive to their babies. If you suspect that your child is getting sick, immediately consult a doctor, because timely treatment will be able to protect his health.

Symptoms and forms of intestinal obstruction in newborns

Intestinal obstruction in infancy can occur in three forms:

Sharp. V this case, there is a cramping pain in the abdomen. It can disappear abruptly after a few minutes, then the sensations become more intense and repeat about every 10 minutes. This is due to the fact that, despite the retention of food in the intestines, the body still tries to perform its functions. There is a process of contraction of the intestinal walls, which is trying to move all the contents in it further. It is because of this that abdominal pain occurs. Other symptoms may also present acute obstruction. For example, bloating and gas retention, nausea and vomiting, which at first occurs as a result of disturbances in all processes in the intestine, and then continues due to intoxication of the body.
Chronic. Often, intestinal obstruction in newborns can develop into a chronic form. Strongly severe symptoms there is no. The doctor may suspect this form of the disease if the child, for some reason, does not gain weight. Sometimes there is nausea and vomiting with impurities of bile, frequent swelling abdomen, especially in the upper part.
Recurrent. The cause of relapses in this disease is volvulus of certain sections of the large intestine. They can also occur due to possible infringement of internal hernias, etc. The same classic symptoms appear: sudden abdominal pain, nausea, vomiting, and constipation. The only difference is that all of the above symptoms can suddenly appear, intensify, and then subside.

Intestinal obstruction in newborns: diagnosis and treatment

It is difficult to diagnose a newborn baby, he cannot describe what worries him and with what intensity. In this case, if the parents have any concerns about the health of the child, they must be sure to show it to the doctor. Only an experienced professional can confirm or deny concerns.

The easiest diagnostic method this disease in young children, an x-ray examination. Using special equipment, it will be possible not only to accurately determine the presence of a disease, but also to understand at what stage it is. However, for complete diagnostics this is not enough, because x-rays do not always show reliable information. At this age, children (especially premature babies) often have disruptions in their work. gastrointestinal tract... In combination with an X-ray, the doctor prescribes additional research- laparoscopy. But given the fact that this is still a surgical intervention (although not a big one), it is done only in exceptional cases.

After determining the diagnosis, the doctor chooses the tactics of treatment, the speed of which directly affects the effectiveness. As a rule, with congenital obstruction, the only method of treatment at any age and at all stages is the intervention of a surgeon. It is impossible to cure this disease with pills. The same thing happens in the case of adhesions, as well as the accumulation of feces in the intestines. The sooner the parents determine the presence of a problem and turn to a specialist, the more less consequences will. If you miss the moment and bring the condition to the necrosis of the intestine, then the only option would be to remove a specific segment of this organ.

When contacting at the initial stage, most often, the doctor prescribes a course of conservative treatment. For example, if a baby has a disease due to helminths or dynamic obstruction, the course will focus on addressing the root cause:

Cleansing enemas to improve bowel function.
Probes inserted into the stomach. They are there constantly, this makes it possible to reduce the load on the digestive tract.
Preparations for increasing the amount of potassium in the body.

Intestinal obstruction among newborns is an extremely dangerous and serious disease that can even end in death. Unfortunately, there are many cases when the disease begins to be treated at an advanced stage. Of course, it is very difficult to diagnose this disease in little child... Despite the extended symptoms of the disorder, children almost always behave in the same way: crying, being capricious, refusing to breast, etc. It all depends only on the parents, who will be attentive to their baby and will turn to the doctor in time. The correct reaction of the mother to the suspicious condition of the baby will help protect his health!

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Intestinal obstruction is a violation of the movement of intestinal contents. It's pretty serious illness which calls pain and vomiting in a child. Often, the disease in children requires a solution to the problem with the help of surgery.

The development of this pathology is associated with gastroenterological problems. The extent of the disease depends on where the blockage occurred. The higher the neoplasm is, the more difficult the treatment will be. As a rule, the signs of the disease appear within a short period of time, there are characteristic symptoms.

Intestinal obstruction in children is a phenomenon of polyetiological syndrome, which is explained by most of the reasons and has various forms. Timely and correct diagnosis is a decisive factor that influences the outcome of the disease.

An acute obstruction of the gastrointestinal tract is treated mainly with the help of an operation.

Disease classification is predetermined by various genetic, anatomical and clinical mechanisms ... How the treatment will be carried out depends on the type of obstruction in the child. Will it be an operation, or intensive therapy.

Depending on the origin, the following types of intestinal obstruction are distinguished:

congenital;
acquired.

From the mechanism of education:

mechanical;
dynamic.

According to the clinical picture:

full;
partial;
sharp;
chronic.

According to the types of compression of the vessels that feed the intestine, there are the following types:

strangulation;
obstructive;
mixed (adhesive).

Congenital

Congenital intestinal obstruction observed as a result of pathologies in the development of the gastrointestinal tract in a child. For some vices that form on early stage, congenital obstruction arises even inside the womb. The course of the disease depends on the degree of obstruction.

When the level is high, then intestinal obstruction in newborns is accompanied by vomiting with impurities of bile. Bloating is observed. During low level obstruction, the main symptoms are stool retention and vomiting, which occurs a few days after the beginning of life.

If congenital obstruction is detected with a delay, then this can lead to organ perforation and cause peritonitis.

Acquired

There are various forms of acquired obstruction. The most common is intussusception or mechanical obstruction. Less often, the adhesive form of the disease manifests itself. It is observed mainly in infants from four months to a year. The disease occurs unexpectedly, is characterized by bouts of pain, subsequently an emetic process is added. Sometimes a child's stool contains blood and mucus.

The main reason for acquired obstruction is stagnation of stool, which occurs due to intestinal weakness.

Mechanical

The obturation and strangulation forms are classified. With obturation, the intestinal lumen is squeezed without compression of the mesentery of the vessels: tumor, feces. The pain is very pronounced, has a cramping character. With the strangulation form, circulatory disorders occur, after which necrosis and may occur.

Dynamic

Dynamic obstruction caused by a slowdown in the regional mesenteric circulation, changes in the central nervous system that regulate the functionality of the gastrointestinal tract. Disruption of the blood circulation leads to inflammatory processes... Among all types of obstruction in children, the dynamic accounts for about 10%. Distinguish between paralytic and spastic forms.

The spastic appearance is characterized by seizures
The spastic appearance is characterized by attacks in the abdomen, the temperature remains normal, and a single discharge of vomit rarely occurs.
The paralytic appearance is the most common and serious complication after surgery.

Formed as a result of paresis, high intraintestinal pressure impedes blood circulation in the intestinal walls. The permeability of the walls increases, and secondary infection of the stomach cavity may occur.

Full

Complete obstruction is a danger to the life of the child. With this form, an urgent operation is necessary. Often, complete obstruction develops after abdominal surgery due to congenital abnormalities.

Partial

It lies in the fact that the intestinal lumen is not completely closed and a certain amount of feces creates difficulties. Most of these situations are associated with slowdowns. muscular apparatus. The main symptoms are bloating, and the stool is thin. Partial obstruction is difficult to detect, so treatment is often late.

Sharp

For acute obstruction characterized by a violation of the passage of intestinal contents in the direction from the stomach to anus... Acute obstruction is a consequence of various diseases, for example, external hernias of the abdominal cavity, tumors in the intestines. In the development of acute obstruction, the following stages are distinguished:

The stage of “ileus cry”, its duration is from two to twelve hours, severe pain prevails.
Then comes the stage of intoxication, lasting from 12 hours to 1.5 days, the intensity of pain decreases. Also, along with this, bloating occurs, a slowdown in the discharge of gases.
The last stage is terminal, occurs after 1.5 days, is characterized by drastic changes geodynamics. Help with acute form must be rendered immediately.

Chronic

Chronic intestinal obstruction characterized by cramping pains which appear several hours after eating. The pain is localized in the lower abdomen. Persistent constipation is observed. Depletion of the body occurs. Children complain of recurrent vomiting.

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Strangulation

Strangulated obstruction represents twisting of the intestine around the longitudinal axis, this species accounts for about 5% of all types of pathology. There are turns of thin, blind and sigmoid colon. The reasons for such obstruction include an increase in abdominal pressure, non-compliance with a diet, prolonged hunger followed by severe stomach congestion.

Obturation

The passage of the intestinal contents is disrupted due to the partial or complete overlap of its lumen, while the mesentery is not squeezed. This type can be triggered by a tumor, inflammation, bowel kinks, foreign bodies.

Adhesive

Adhesive obstruction occurs due to disorders that provoke the adhesion process in the abdominal cavity - this is the most common form. Today, the number of diseases with this type is growing due to the increase in the number of abdominal surgeries. Adhesive disease is caused by inflammation of the peritoneum.

Causes

There are very many reasons for obstruction in a child. a large number of... The most common causes:

congenital pathology;
structural irregularities internal organs;
, one of the sections of the intestine;
inflammatory processes;
penetration of foreign objects;
accumulation of adhesions;
hernias, neoplasms;
mobile cecum;
fecal and gallstones.

Symptoms

The main symptoms observed in children during intestinal obstruction:

abdominal pains that are cramping in nature;
bloating;
refusal to eat;
nausea, recurrent vomiting;
dehydration of the body;
flatulence;
stool retention;
difficulties in removing feces.

If you find symptoms of the disease in a baby, you should immediately seek help, since obstruction may have acute course, and belated diagnosis can lead to bad consequences... There is a high likelihood of death.

Treatment

Treatment of the disease cannot be postponed. The little patient should be immediately hospitalized in the surgery department. Before a full examination by a doctor, it is not recommended to give a laxative or do a gastric lavage.

Treatment is prescribed only after comprehensive survey... Surveys to detect obstruction are performed by a surgeon. If the baby has complications, then only surgery will be prescribed.

If the disease is not in an acute form, then procedures are carried out to relieve pain, cleanse the intestines with an enema, intensive therapy, and take measures to update the water-salt balance.

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Conservative therapy

Held when not serious complications. Treatment consists of a set of measures to remove stagnation in the intestines and combat poisoning of the body. The little patient is prescribed hunger and rest, intensive therapy is carried out, including the following stages:

use a flexible umbrella that is inserted through nasal cavity into the stomach. Thus, the upper sections are freed digestive tract from stagnation of food, it helps to stop vomiting;
intravenous solutions are injected that renew water-salt balance organism;
enter enemas with hypertonic solutions, as well as siphon ones - with sodium chloride solution;
if the child has intussusception, then during the day the intussusception is straightened by introducing air into the rectum;
pain relievers and antiemetic medications are prescribed;
when peristalsis is strongly expressed, antispasmodic drugs (no-shpa) are used;
to stimulate the intestines, proserin is injected subcutaneously.

Treatment of the paralytic form occurs with the help of medications that help to contract the muscles and move along the gastrointestinal tract. Such obstruction is temporary, and with proper treatment, the symptoms disappear after a few days.

Operation

When conservative therapy does not have the desired effect, then surgery is performed. The operation aims to liquidate mechanical blockage, removal of the affected intestine, prevention of repeated cases of obstruction.

In the course of the operation, the following activities are carried out:

Eliminate an obstacle that prevents content from moving forward. When the operation is performed on the small intestine, then a resection is performed, which completely restores patency. Sometimes, to eliminate the problem, surgery is performed several times;
All dead tissue must be removed. It is better to remove a little more of the affected tissue and to rule out re-obstruction;
After surgical intervention continue to administer saline solutions to reactivate electrolyte balance... Anti-inflammatory therapy is also carried out.

In the first days after the operation, the little patient must lie in bed. You cannot drink and eat for the first 12 hours. Feeding is carried out intravenously using a tube.

Laxative

During a mild course of the disease, in order to alleviate the symptoms in a child, it is possible to use laxatives, including those prepared on their own.

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Plum Juice

Before applying medications try making a natural laxative. You can use plum juice diluted with water, about 50-50. It is allowed to use 2 tablespoons for a child from four months. For a kid from one to two years old, give a glass of prepared liquid. You can also serve plum puree.

Fruits have a good laxative effect: pear, prunes, peach.

Maltsupex

The over-the-counter laxative Maltsupex, which contains maltose and barley extract, can soften your child's stool. For a baby from one to two years, give 1 tbsp. l. a day, mixing with a glass of water. As soon as the stool returns to normal, the dosage should be reduced.

Candles

Laxative suppositories (suppositories). it glycerin candles, which include a laxative component. It can be used periodically when the constipation is severe and the above remedies do not help.

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Diet

Diet is an important prerequisite for keeping your baby healthy. You need to eat at the same time, you do not need to make large intervals between meals, you should not overload the stomach. Meals should be in small portions. The diet involves the elimination of fermentation and putrefactive processes in the gastrointestinal tract. The diet should be as gentle as possible.

Foods that cause gas (milk, soda, peas, legumes) should be excluded from the diet.
The menu should consist of low-fat meat broths, mashed or mashed dishes. Steam the meat, in the form of cutlets and meatballs.
The diet must necessarily include fruit jelly, jelly, dairy products.
The diet for obstruction recommends the use of carrots, beets, vegetable oils.
The diet excludes flour products, pickles, sweet, fried meat and fish. It is not recommended to give your child raw vegetables, pasta.
As for drinks, the diet includes green tea, decoctions of wild rose. It is strictly forbidden to drink soda and cold drinks.

During intestinal obstruction, the diet helps to unload it, helps to improve the well-being of the child and prevents the development of exacerbations.

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The disease can occur in different forms... It is important to diagnose it in a timely manner and start treatment, otherwise severe complications may occur, leading even to death. At the first symptoms, consult a specialist and undergo a comprehensive course of treatment.

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 light massage(stroking) the abdomen. However, you should not be lighthearted about the child's discomfort and think: "It will pass by itself!" Sometimes abdominal pain is a symptom of such a formidable 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

Intestinal obstruction can be caused by 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 with any formation);
strangulation (due to squeezing of the intestinal area);
dynamic.

Causes of intestinal obstruction

The causes of intestinal obstruction in children can be:

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

Congenital intestinal obstruction associated with malformations of the organs of the digestive tract: lengthening of the intestinal area (more often it is the long sigmoid colon) or narrowing of its lumen.

One of the options for congenital narrowing of the lumen is pyloric stenosis: a narrowing of the pulp 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 a baby's life it manifests itself profuse vomiting in the form of a fountain.

In infants, among the causes of obstruction, there may be an individual atypical arrangement of the intestines or volvulus of its loops.

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

Coprostasis, or the accumulation of feces in the intestinal lumen, can lead to intestinal obstructive obstruction in older children. The cause of coprostasis is a decrease in the tone of the intestinal wall and a violation of peristalsis. It can also be noted with a congenital defect: an elongated sigmoid colon. Coprostasis may obstruct the lumen of the end portion of the small intestine or colon.

In infants and newborn babies, this functional inferiority of the digestive tract can occur after a birth injury, against the background, after surgery on the abdominal and chest cavity, at intestinal infections... At an older age, it often develops with serious illnesses due to toxic effects (for example, with sepsis) and in the postoperative period.

In terms of severity, obstruction is complete and partial. At partial obstruction, the intestinal lumen is narrowed, but not completely blocked (for example, with dynamic obstruction) or it is blocked by some obstacle, but not completely. The intestine remains partially passable for intestinal contents.

In addition, distinguish high obstruction (occurs in small intestine) and low(the large intestine is impassable).

Symptoms

The clinical manifestations of the disease are different:

Pronounced is the constant and most early symptom... At first, they are cramping in nature, renewed every 10 minutes. Pains appear suddenly, sometimes at night, and do not have a clear localization.

Recurrent bouts of pain are associated with intestinal motility, which is still trying to push the contents. Then the muscles of the intestinal wall are depleted, the process goes into the stage of decompensation, the pain is permanent. On the 2-3rd day, the pain subsides, but this is a bad prognostic sign.

- too early sign with low obstruction. With high obstruction at the beginning of the disease, stool may appear, sometimes even multiple: emptying of the intestine, located below the impassable area, occurs.

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

In the chair may be noted bloody issues characteristic of intussusception. In these cases, it is necessary to differentiate obstruction from.

At partial obstruction may also be noted loose stools with an unpleasant putrid odor.

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

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

With pyloric stenosis, vomiting is first noted about 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 (vomiting "fountain"). Dehydration develops, weight loss.

The child becomes restless, cries, the expression on his face is painful, it is noted increased sweating, the pallor of the skin is expressed.

Diagnostics

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

Interviewing the child (if possible by age) and parents: allows you to find out the time of the onset of the disease, complaints, the dynamics of the development of the disease, the individual characteristics of the child's body.
Inspection makes it possible to evaluate general state child, to reveal the soreness of the abdomen and its localization, bloating, the nature of vomit and stool (if any), tension of the abdominal muscles, the state of the cardiovascular and respiratory systems and etc.
With the help of an X-ray examination, you can early diagnosis intussusception, to confirm the presence of pyloric stenosis, lengthening of the sigmoid colon, etc. By the decision of the doctor, in some cases, air injection into the intestine through the rectum is used, and in some studies, barium is used.
In cases difficult for diagnosis, a study by laparoscopy is used (with adhesive obstruction, volvulus, etc.).
Ultrasound of the abdominal organs is used as an auxiliary examination method.

Treatment

If a child develops abdominal pain, an urgent consultation with a surgeon is necessary! Self-medication attempts 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 operative.

The choice of treatment method depends on the timing of the request for medical help and forms of obstruction. So, with 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 particular severe cases sometimes it is necessary to bring the intestine to the anterior abdominal wall.

With late treatment for help and the development of necrosis (necrosis) of the intestine, during the operation, the affected area of the intestine is removed. If peritonitis develops, complex treatment including antibacterial drugs, detoxification therapy, pain relievers and vitamins, and symptomatic treatment.

With an early visit to a doctor about intussusception (no later than 12 hours from the onset of the first symptoms) conservative treatment ... With the help of a special apparatus, air is pumped into the intestines and they are trying to spread the invaginate under the control of an x-ray apparatus.

To make sure that the bowel has completely expanded, the child remains under the supervision of a doctor in the hospital. Excess air from the intestines exits through gas outlet pipe injected into the rectum. A control X-ray study is carried out using a barium suspension. If the intussusception is straightened, then after about 3 hours barium enters the initial section of the large intestine, and later is excreted in the feces.

Intestinal obstruction- the most common manifestation emergency v abdominal surgery during the neonatal period. The cardinal sign of intestinal obstruction is vomiting with an admixture of bile. With high obstruction, vomiting is pure green, while with low vomiting, it is initially green in color, but over time there is an admixture of feces in the vomit. If the obstruction occurs above the nipple of Vater, vomiting will be bile-free, but strong and constant. The degree of bloating (Figure 12-1) depends on the level of development of the obstruction. With high obstruction, only the upper abdomen is swollen. With low obstruction or with significant pneumoperitoneum, observe severe swelling abdominal cavity sufficient to cause a disturbance respiratory function... With complete obstruction in the infant, meconium cannot be passed or the stool is represented by a small amount of mucus. In some infants with intestinal atresia, a small amount of meconium is observed, which entered the distal intestine before the onset of atresia. Anterior edema abdominal wall and / or erythema around the umbilicus indicates perforation, peritonitis, impending or advanced bowel necrosis.

A plain abdominal x-ray is usually the only x-ray examination required. It helps determine the level of obstruction, provide Additional information, for example, to detect the presence of free gas in the abdominal cavity in the case of perforation, calcification of the intestine with prenatal perforation or pneumatosis of the intestine in necrotizing enterocolitis.

In doubtful cases with incomplete high obstruction, for example, in the case of malrotation (incomplete bowel rotation), the most preferred method is radiopaque examination upper divisions Gastrointestinal tract. If low obstruction is suspected, an irrigoscopy will help determine if the colon and rectum are involved or if the obstruction is distal small intestine... It is impossible to distinguish between the small intestine and the large intestine on a plain x-ray.

When conducting an ultrasound scan, which becomes recent years more and more sensitive, in the antenatal period it is important to consider two points. At first, congenital disorders development began to be diagnosed more often. For example: prenatal diagnosis umbilical hernia or gastroschisis, the appearance of a "double bladder" with duodenal atresia and multiple dilated loops with intestinal atresia. Second, ultrasound doctors are now describing the finding of dubious signs, such as "hyperechoic" gut, a symptom reportedly associated with a diagnosis of meconial ileus and cystic fibrosis. However, the sensitivity and specificity of such signs is low, so an official prospective study is planned.

Another example is the detection of intra-abdominal dilatation of the intestine during gastrosis. This would suggest that the size of the gastroschisis defect is narrowing and can lead to necrosis of the portion of the intestine located outside the abdominal cavity. Urgent delivery under these circumstances may prevent the need for subsequent extensive bowel resection at a later date. Consultation before delivery is the main and important task pediatric surgeon, close collaboration with obstetricians and neonatologists is necessary.

Infants with suspected intestinal obstruction for further treatment should be placed in a portable incubator in a specialized pediatric surgery department... A nasogastric tube (8-10 Fr diameter) should be inserted and aspirated at short intervals. For the rest of the time, a free outflow of gastric secretions must be maintained. In the clinic where the child is placed before being transferred to a specialized department, it may be necessary to restore the volume of circulating blood. If there is hypovolemia, a primary intravenous administration human albumin solution 20 ml / kg or isotonic saline solution... In other cases, a 0.18% solution of sodium chloride in 10% glucose is used at a dose of 4 ml / kg per hour. Fluid loss through a nasogastric tube is compensated for with an equal volume of isotonic saline solution containing 10 mmol of potassium chloride per 500 ml (final concentration 20 mmol / L) of fluid.

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

Description of pathology

Intestinal obstruction in children is a pathology associated with a failure in the process of pushing chyme (split food with digestive juice) through the lumen. In babies of the first year of life, the disease is accompanied by severe pain, cramps, vomiting. The bulk is used surgical tactics elimination of pathology, especially in newborns. Older children are prescribed conservative treatment and diet.

In infants, the disease causes severe spasmodic pain.

Children's intestinal obstruction is a kind of blockage of the lumen. The complexity and severity of the disease depends on the localization of the problem - the higher the blockage occurs, the harder the disease will pass. A feature 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 by medication, then acute - only surgically.

Classification of intestinal obstruction in children

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

By origin, they distinguish between congenital and acquired forms.
By the mechanism of education - mechanical, dynamic.
According to the characteristics of the symptomatology - complete, partial, acute, chronic.
By the nature of the compression of the vessels supplying the intestine with blood, it is strangulated, obstructive, 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 developmental abnormalities, so the newborn suffers from severe symptoms of dysfunction from the very first hours. With a particular severity of the course, the baby develops vomiting of bile, bloating. With a mild form of the disease, constipation, vomiting are observed. If this pathology is detected late, the risk of intestinal rupture increases. Manifestations congenital pathology are stenosis (vasoconstriction, lumen), atresia (fusion of the walls of organs), inflammation. This form is typical for newborns.

Acquired

Pathology is provoked by external or internal unfavorable factors. It develops more often in infants aged from 4 months to a year in the form of intussusception (penetration of one part of the intestine in another) or a mechanical disorder. Adhesions are rare. Salient features illness is an unexpected, paroxysmal pain syndrome, which goes into vomiting, and blood with mucus is found in the stool. Childhood illness requires immediate hospitalization of the baby.

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

Dynamic

Surges in intraintestinal pressure provoke peritonitis.

The development of this form is provoked by a weakening of the regional blood supply to the mesentery, a violation of the water-electrolyte balance, and dysfunction of the central nervous system departments responsible for correcting the work of the gastrointestinal tract. As a result, inflammation develops. The incidence is 10% of all fixed 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 rupture of the intestine and peritonitis;
spastic pathologies characterized by excessive muscle tension, paroxysmal pain abdomen, lack of temperature jump, 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 abdominal cavity... Depending on the causal factors there are such subforms:

Each of the listed types of intestinal obstruction in infants and older children is different characteristic symptoms but there are common features pathologies such as: