Introduction to acute intestinal obstruction in children. Causes, symptoms and methods of treatment of intestinal obstruction in children. Basic rules for feeding a baby after an illness

Bowel obstruction in children is a common disorder that occurs among different age groups. The disease is a malfunctioning of the gastrointestinal tract and is characterized by a violation of the movement of food particles or other intestinal contents through the rectum. Among the reported cases, the disease is diagnosed more often in boys than in girls. The main age of development of such a pathology is the first year of life.

The disease can be either congenital or acquired. There may be several factors for the formation - the premature start of feeding infants, inappropriate nutrition and lack of its regime, the individual structural features of this organ and the course of inflammatory processes of various nature.

A clinical manifestation can occur in a seemingly perfectly healthy child. Symptoms are paroxysmal in nature and are expressed in significant soreness, impossibility of the process of defecation, bouts of vomiting and nausea. An increase in temperature indicators is often observed.

Diagnostic measures consist of a whole range of tools and include - physical examination, laboratory and instrumental examinations. Treatment of such a disease in a child is carried out through the use of drugs and surgical intervention.

Etiology

The predisposing causes of the onset of the disease depend on the age group of children. Intestinal obstruction in newborns is caused by:

• improper and early feeding for babies, before four months;
• lack of a normal diet in babies of the first year of life;
• a delay in the introduction of complementary foods, as well as prolonged feeding only with breast milk;
• insufficient formation of the gastrointestinal tract;
• structural features of the digestive tract, in particular the intestines;
• congenital lengthening of this organ, as well as a wide range of disorders during intrauterine formation;
• the presence of intestinal diseases, of an inflammatory nature.

In children over 2 years old, among the sources of appearance can be distinguished:

• the formation of benign or malignant neoplasms;
• the presence of fecal stones - the masses harden against the background of a violation of the digestive process or an unsuitable diet for the age group;
• the formation of polyps on the shell;
• entry into the intestine of a foreign body, which leads to blockage of the lumen of this organ;
• the course of adhesive or cicatricial disease, as well as ailments of the genitourinary system;
• volvulus;
• complications after medical intervention;
• immobilization of the large or small intestine;
• intussusception is a condition during which one part of the intestine is introduced into the lumen of another.

Classification

Modern pediatric gastroenterology knows several types of intestinal obstruction in children. By the nature of the origin, the disease is divided into:

• congenital obstruction- arises as a result of intrauterine pathologies of the development of the gastrointestinal tract in a child, which is why the baby has symptoms of ailment from the first days of life. To prevent the reappearance of the disorder, patients are advised to lead an active lifestyle and follow a diet;
• acquired obstruction- the main source of appearance is intussusception. This form, in turn, is divided into several types. It is diagnosed mainly in infants from the fourth month to one year of age. It differs in that it has a sharp and unexpected character of the appearance of signs. In children over 2 years of age, the disease can be observed, but is rare.

Acquired intestinal obstruction in children is divided into several types:

• mechanical- occurs due to tumors and fecal stones. In this case, there is a manifestation of severe, cramping pain and a violation of the blood circulation process. This can lead to tissue death and peritonitis;
• dynamic- this type of disease develops against the background of previously received injuries or previous operations;
• adhesive- based on the name, the pathology is provoked by the presence of an adhesive process and inflammation in the abdominal cavity. This is the most common form of this disease in children;
• obstructive;
• strangulation- the main reasons for the appearance are considered - improper diet, an increase in intra-abdominal pressure, prolonged fasting, followed by congestion in the stomach.

By the nature of the spread of the disease-causing process, the disease is divided into several forms:

• complete obstruction- often this type is formed as a result of congenital intestinal obstruction and operations designed to eliminate it;
• partial obstruction- differs in that the intestinal lumen is not completely closed. This type can be quite difficult to detect, which is why therapy begins at a later stage of the course.

By the nature of the course, intestinal obstruction in newborns and children under 2 years of age is divided into:

• acute- is a consequence of various disorders of the gastrointestinal tract, hernias and tumors in the intestine. It develops to the terminal stage during the day, which is why medical care should be provided as soon as possible after the onset of symptoms;
• chronic- differs in a lighter course. Children suffer from pain in the lower abdomen and constant constipation. Depletion of the organism gradually sets in.

Depending on the intussusception, acquired or congenital intestinal obstruction is:

• small intestine;
• colonic;
• small intestinal- in which part of the small intestine is introduced into the large one.

Symptoms

Acute intestinal obstruction in children manifests itself sharply and unexpectedly. Each of the varieties of the disease has a characteristic manifestation, but there is a group of symptoms that accompanies any course of the disease. The symptoms of the disease are:

• pain syndrome - is cramping in nature. During an attack, the pain is expressed so strongly that often children experience a painful shock;
• attacks of nausea with frequent vomiting. Profuse vomiting does not give relief to the baby's condition. With the defeat of the large intestine, vomiting may be absent altogether;
• violation of the defecation process, or rather, complete stool retention. Children suffer from constipation, which can only be eliminated with an enema;
• an increase in the size of the abdomen;
• an increase in body temperature indicators;
• increased gas formation;
• decreased appetite;
• the stomach ceases to be soft and elastic, which is why it takes on an irregular shape;
• signs of dehydration.

If you do not provide assistance to the child in a timely manner, the above symptoms become more intense.

Diagnostics

To establish the correct diagnosis, a small patient will need to undergo a whole range of laboratory and instrumental diagnostic techniques. But before prescribing them, the doctor needs to independently perform some activities:

• study the history of the disease, analyze the life history of the child and close relatives - this will help determine some of the causes of the formation of the disease, as well as distinguish congenital intestinal obstruction from acquired;
• conduct a thorough examination of the child, with obligatory palpation of the abdomen, and interview the parents for the first time of appearance, as well as the degree of intensity of the manifestation of symptoms.

After that comes the stage of laboratory research, which includes:

• assessment of feces - with such a disorder, it acquires a reddish tint and contains impurities of blood;
• general and biochemical study of blood - a way to detect changes in its composition and associated disorders;
• analysis of feces for occult blood - if internal hemorrhage is suspected;
• general analysis of urine.

But the basis of diagnostics is made up of instrumental examinations, implying the implementation of:

• Ultrasound - will make it possible to detect intussusception and other internal causes of the onset of the disease;
• contrast-enhanced x-rays - procedures to detect specific signs of bowel obstruction.

Treatment

After receiving and studying all the examination results, the specialist prescribes the most effective method of treatment. There are two of them - conservative and surgical.

Before performing drug therapy, the little patient is shown to ensure complete rest, therapeutic fasting, after which dietary food is applied. In addition, conservative therapy includes:

• probing - necessary to free the digestive tract from food accumulation. This can relieve the baby from gagging;
• injections of solutions to restore water-salt balance;
• the use of enemas;
• introduction of air into the rectum - which promotes the expansion of intussusception;
• taking painkillers, antispasmodics and antiemetic drugs;
• subcutaneous administration of substances to stimulate the functioning of the intestines.

In cases of ineffectiveness of previous methods of therapy or with a severe course of the disease, medical intervention is prescribed. This method of treatment is carried out by specialists in the field of pediatric surgery. The operation is aimed at removing mechanical blockage, excision of dead intestinal tissue and prevention of recurrence of the disease.

In addition, the complex therapy includes adherence to dietary nutrition. In cases of performing the elimination of the disease by surgery, the patient is prohibited from eating and drinking for twelve hours. After that, gentle nutrition will consist of principles such as:

• complete exclusion from the baby's diet of foods that contribute to increased gas production;
• refusal from confectionery, pickles, fatty meats and fish. It is not recommended to give boiled pasta and raw vegetables;
• all dishes should be boiled or steamed, best of all in a puree state;
• You can drink warm green tea. It is forbidden to give the child cold and carbonated drinks.

There is no specific prevention of acquired or congenital intestinal obstruction in newborns and children in the first year of life. It is only necessary to introduce complementary foods in a timely manner and, if the first symptoms appear, immediately seek help from specialists.

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Dyspepsia in children is a fairly common disease characterized by impaired digestion. Often, such an ailment is diagnosed in children in the first year of life, and the severity of the course directly depends on the amount of food consumed. This is due to the fact that the volumes of food consumed do not always correspond to the capabilities of the gastrointestinal tract. There are several types of this syndrome in children - simple and toxic. In the first case, the functioning of the digestive tract is disrupted, in the second, metabolic disorders are observed.

Intestinal obstruction is a violation of the movement of intestinal juices and digested food through it. The disease can cause many dangerous complications, especially in children. Intestinal obstruction in newborns in almost all cases requires urgent surgical intervention.

The disease in children is common and in most cases is associated with gastroenterological problems. The complexity of the course always depends on where in the intestine the blockage is formed - the higher it is, the more acute the symptoms of the disease in the child and the more difficult it is to carry out the treatment.

The onset of the disease is characterized by rapidity: the symptoms appear within a short period of time and rapidly intensify.

Intestinal obstruction can be not only acquired, but also congenital, which is associated with anomalies and pathologies of the development of the gastrointestinal tract in the prenatal period.

Acquired obstruction has various reasons, depending on which the disease is divided into two types: mechanical disturbance and dynamic.

Mechanical obstruction occurs when tumors or hernias form in the abdominal cavity that block the intestines and prevent it from functioning normally. Violation may appear after some operations with the formation of adhesions, transfer of diseases and even taking certain medications, as a side effect.

Mechanical obstruction in a child also includes conditions such as intestinal volvulus and intussusception, when one of the sections of the intestine penetrates into the lower zone and forms a blockage.

In most cases, mechanical obstruction occurs in the small intestine, but sometimes a blockage of the large intestine can occur. The causes can be diseases such as colon cancer, volvulus, diverticulitis, narrowing of the lumen caused by the formation of scars or inflammation, strong compaction of stool.

Dynamic obstruction is divided into:

• spastic, caused by prolonged tension of the intestinal walls;
• paralytic or functional, caused by complete relaxation of the intestines.

Functional obstruction may have general symptoms and signs, but no mechanical blockage is formed. The intestine cannot function normally due to nerve or muscular disorders, causing a decrease in the number of natural contractions or their complete cessation, which greatly complicates the movement and excretion of the contents.


The reasons for the appearance of paralytic obstruction in any intestinal section can be:

• operations performed on the organs of thesis and abdominal cavity;
• some medications;
• intestinal infections;
• Parkinson's disease and other disorders of a nervous or muscular nature.

Symptoms of Bowel Obstruction in Newborns

The reason for the appearance of obstruction in newborns is the pathology of intestinal development, narrowing of the lumen or lengthening of some areas, as well as the individual characteristics of the structure and location of intestinal loops.

Violation symptoms:

• severe bloating without gas;
• retention of meconium stool, its complete absence or a meager amount;
• vomiting, often mixed with bile;
• strong polyhydramnios in the prenatal period.

The causes of violations can be the presence of diabetes in the mother, as well as atresia of the small intestine and Hirschsprung's disease.

If the small intestine or duodenum of the newborn is severely narrowed or absent, a discharge of mucous lumps from the rectum can be observed. They do not contain an admixture of skin cells of the surface layers, which are always present in the amniotic fluid and are swallowed by the developing baby inside. Such cells are always present in infant meconium during normal bowel function.

Symptoms in children under one year old

At this age in children, the disorder has its own specifics. The most common cause of obstruction in infants is intussusception, when part of the intestine, having turned out, falls into the lower section and leads to the formation of a blockage. Most often, this condition occurs in boys between the ages of 5 and 10 months. This disorder is rare in older children.


The cause is usually intestinal immaturity and instability in the work of its mechanisms, which, as a rule, disappears as the child grows. Other factors can also lead to disruption of the natural work of the intestines, for example, the introduction of a new product into the diet of the baby, a change in diet (a sharp forced transition from breastfeeding to artificial feeding), infections.

Signs of intussusception:

• vomit;
• frequent bouts of pain in the abdomen;
• the presence of bloody discharge with mucus instead of feces;
• bloating;
• seals in the abdominal cavity, clearly palpable on palpation;
• attacks of pain with a sudden sharp appearance and the same ending, after a short time they are repeated, from which the babies cry, scream and are very anxious.

In the presence of acute low obstruction caused by the presence of an obstruction in the lower part of the small intestine or in the large intestine, the child has no stool at all, the abdomen is very swollen due to accumulated gases, and vomiting appears with the smell of feces.

Symptoms of children after a year

In babies older than a year, the disease manifests itself sharply, so parents can usually name not only the day of the problem, but also the almost exact time. The child develops severe pains in the abdomen, vomiting, while there is no stool and gases do not escape, the accumulation of which causes visible bloating. Toddlers cannot sit still, are constantly looking for a comfortable position and may periodically scream in pain.

The type of obstruction can be determined by a set of signs, for example, the closer the resulting blockage is to the stomach, the stronger the vomiting will be and the earlier it will appear. If the problem is in the large intestine, vomiting is usually absent, but children have a painful urge to defecate, accompanied by severe bloating, which causes the babies to cry loudly and violently.

In the presence of intussusception from the rectum, bloody discharge may be observed, which indicates tissue damage and the presence of severe irritation of the intestinal walls.


If you do not provide the baby with timely assistance, necrosis of intestinal tissues may begin, as evidenced by a decrease in pain sensations against the background of a sharp deterioration in the general condition.

An important sign of a disorder in children over a year old is the presence of Valya's symptom, when there is a stable, often asymmetric swelling of the abdomen, visible to the eye and clearly palpable on palpation, while the formed tumor does not shift.

Diagnostics

Symptoms of the disorder are pronounced, which allows parents to detect the problem in time and consult a doctor, in this case, a surgeon, since only he will be able to accurately diagnose and provide assistance to the child. If it is not possible to go to the surgeon, you need to show the child to the pediatrician, but in no case should you self-medicate.

Diagnostic measures include:

1. Examination of the baby, assessment of his condition, identification of symptoms.
2. Collecting anamnesis.
3. General blood analysis.
4. X-ray of the abdominal cavity.
5. An ultrasound scan can also be performed, but such a procedure for obstruction is not particularly informative.

Treatment

Any kind of intestinal obstruction in babies requires compulsory hospitalization, since children can only be helped in a stationary setting.

To stabilize the condition:

1. A dropper is installed with a solution to restore the water-salt balance in the body.
2. When the abdomen is bloated, a special probe is also installed, inserted through the nose, the purpose of which is to remove accumulated gases and liquids.
3. A catheter is placed in the bladder to drain urine and conduct tests.

Conservative therapy can be carried out only in cases where the baby has no serious complications with intestinal obstruction. A set of measures will be aimed at eliminating stagnation in the intestines and eliminating the consequences of poisoning the body.


Conservative measures include:

• Lavage of the stomach and esophagus through a special probe. The procedure allows you to stop the emetic process.
• Conducting enemas with hypertonic solutions.
• Siphon enemas using sodium chloride.
• The introduction of intravenous water-salt solutions.
• Introducing air into the baby's rectum with intussusception. The purpose of the procedure is to straighten the formed intestinal fold.
• Prescription of medications, antispasmodic, antiemetic, pain relievers.
• At the end of all procedures, with the successful elimination of the problem, the baby is injected subcutaneously with proserin, which helps to stimulate the proper functioning of the intestines.

Paralytic forms of obstruction are treated with drugs that cause contractions of the intestinal muscles, which contributes to the rapid movement of the contents to the exit, as well as laxatives.

Surgical treatment (operations)

Surgical intervention is used in cases of direct indications for surgery or when conservative methods of treatment have not yielded the necessary results. The operation is aimed at eliminating the problem, that is, at removing the area of ​​the affected intestine, eliminating the resulting mechanical blockage and taking measures to prevent the recurrence of the violation.

In especially difficult and severe cases, it may be necessary to carry out several operations to eliminate the obstruction and prevent the occurrence of such a problem in the future.

Lifestyle and nutrition during treatment

During the period of conservative therapy, as well as surgical treatment, the child needs rest and hunger. It is important to make sure that the baby strictly follows the instructions of the doctors and does not take any food without their permission. The same goes for drinking fluids.

After eliminating the obstruction by conservative methods, a small patient is prescribed a special gentle diet that restores the normal functioning of the intestines and its microflora. In the case of an operation, the intestines are stimulated with medications, gradually allowing the baby to take light food in small portions.

In the future, difficult to digest foods, vegetables and fruits, which have a fastening effect and cause constipation, should be excluded from the diet of a small patient. The child's menu should contain fermented milk products, cereals, jelly, light meat broths and soups based on them, boiled and steamed lean meat, fruit jellies, rosehip broth, green tea.

Constipation problem in children

Undiagnosed or improperly controlled obstruction leads to damage to the intestinal vascular system. This reduces its blood supply, then tissue death, destruction of the intestinal walls, infection of the whole organism occurs. This is fatal.

Varieties of intestinal obstruction in a newborn: criteria for classification

Many different pathological processes can cause intestinal obstruction in children.

Share congenital and acquired obstruction. Congenital intestinal obstruction is caused by a violation of the intrauterine development of the child.

Its reasons may be:

• embryonic intestinal malformations;
• violation of the intestinal rotation process during the formation of the gastrointestinal tract;
• pathology of the development of other organs of the abdominal cavity.

Acquired intestinal obstruction in children is the result of inflammatory processes or surgery.

There are several classifications of intestinal obstruction according to various criteria:

1) The presence or absence of a physical obstacle

Intestinal obstruction are divided into: mechanical and dynamic.

• mechanical obstruction Is a physical blockage of the intestine by a tumor, scar tissue, or other type of block that prevents intestinal contents from passing through the point of blockage;
• dynamic obstruction occurs when the healthy undulating contractions of the muscles of the intestinal walls (peristalsis), which move the products of digestion along the gastrointestinal tract, are disturbed or stopped altogether.

2) The level of the affected area of ​​the intestine

it high and low intestinal obstruction:

• high intestinal obstruction in newborns is observed with atresia (overgrowth) or stenosis (narrowing) of the duodenum;
• low intestinal obstruction can result from atresia or stenosis of the small intestine, ileum and ascending colon.

3) The degree of obstruction:

• complete intestinal obstruction. With her, there is an absolute absence of stool;
• with partial obstruction, a small amount of stool passes.

4) The rate of development of symptoms:

• acute intestinal obstruction in children is characterized by rapidly developing symptoms;
• chronic. It is characterized by slowly developing symptoms, pain may not appear. More common with high intestinal obstruction.

Symptoms of intestinal obstruction in acute form, as opposed to chronic, slowly progress, but tend to suddenly intensify or accelerate.

5) Number of points of obstruction:

• simple obstruction. This is when there is a violation of the movement of intestinal contents due to the presence of a physical obstacle closing the lumen, but the contents of the lumen can move back;
• closed loop. This occurs when the intestinal lumen is blocked at two points at which the contents of the intestine are unable to move forward or backward;
• restrained obstruction. It occurs when there is a violation of the blood supply to the occluded segment.

Obstruction reasons

The causes of obstruction of the small intestine in children are most often there may be the following:

• intussusception, volvulus, adhesions;
• hernia.

The most common causes of colon obstruction are:

• volvulus;
• tumors;
• diverticula. These are small sacs that form in the intestinal wall that can fill with food and expand, blocking the intestines.

Mechanical obstruction in children under one year old can occur due to intussusception, volvulus and hernia.

Meconium obstruction

Meconium ileus in newborns is a disorder in which meconium (original feces) is abnormally dense and fibrous, rather than a collection of mucus and bile that usually comes out easily. The abnormal meconium is blocking the intestines and must be removed with an enema or surgery.

This is due to a deficiency in trypsin and other digestive enzymes produced in the pancreas. It is also one of the earliest signs of developing cystic fibrosis in an infant. Intussusception usually follows an infection that causes an enlargement of the lymph node in the intestine, which acts as a folding point for intussusception.

Hirschsprung's disease

Hirschsprung's disease (congenital megacolon), possibly associated with meconium obstruction, is a motor disorder that occurs in 25 percent of newborns with dynamic intestinal obstruction, although symptoms may only develop in late infancy or childhood, delaying diagnosis.

Children with Hirschsprung's disease lack nerve cells (ganglia) in the walls of the large intestine. This seriously affects the undulating motion that propels the digested food forward. In most cases, in children with this disease, the first sign is the absence of stool with meconium in the first two days after birth.

From birth to 2 years of age, these babies will develop other signs such as chronic constipation, occasional watery stools in small quantities, a distended abdomen, poor appetite, vomiting, poor weight gain, and developmental delay. Most children will need surgery to remove the affected part of the colon.

Surgical intervention can be performed at the age of six months, or immediately after the correct diagnosis is made in an older child.

Symptoms can be resolved in at least 90 percent of cases born with Hirschsprung's disease. The disease is sometimes associated with other congenital conditions such as Down's syndrome.

Volvulus

Volvulus is the self-twisting of the small or large intestine (malrotation). Colon volvulus rarely occurs in young children. It usually occurs in the sigmoid colon - the lower part of the large intestine.

Duodenal valve

The duodenal seal occurs when the duodenum is twisted, the section of the intestine that connects the stomach and small intestine. Twisting any part of the intestine interrupts the flow of blood into the intestinal loop (strangulation), reducing the flow of oxygen to the tissues (ischemia) and leading to death of the intestinal tissue (gangrene).

Asphyxiation occurs in about 25% of bowel obstruction cases and is a serious condition that progresses to gangrene within half a day.

Intussusception

Intussusception is a condition where the intestine folds into itself, like a radio antenna. Intussusception is the most common cause of intestinal obstruction in children from three months to six years of age.

Adhesions and hernias

Hernias can also block part of the intestines and block the passage of food.

Congenital or post-surgical adhesions also lead to intestinal obstruction in children. Adhesions are strips of fibrous tissue that connect to each other, or to abdominal organs and intestinal loops. Thus, the space between the walls of the intestine is narrowed, and, by pinching parts of the intestine, the passage of food is blocked.

In adults, adhesions are most often caused by surgery. Children who have had abdominal surgery may also develop adhesive ileus. It is not known exactly what causes the abnormal growth of fibrous tissue in congenital adhesions.

Symptoms of intestinal obstruction in children

The symptoms of bowel obstruction are variable.

Some of them are more common or appear earlier than others. It depends on the location and type of blockage.

1. Vomiting usually occurs early, followed by constipation. This is the case when the small intestine is involved.
2. Early onset of constipation accompanied by vomiting is more common with a blockage in the colon.
3. Symptoms of a blockage in the small intestine tend to progress more rapidly, while symptoms of a blockage in the colon are usually milder and develop gradually.

It is difficult to diagnose any type of bowel obstruction in infants because young children are unable to describe their complaints.

Parents need to watch their child for changes and signs that indicate obstruction.

1. The first signs of mechanical intestinal obstruction are abdominal pain or cramps that come and go in waves. The kid, as a rule, squeezes his legs and cries in pain, and then suddenly stops. He may be calm for a quarter or half an hour between crying attacks. Then he starts crying again when another attack comes. Spasms are caused by the inability of the intestinal muscles to push the digested food through the blockage.
2. The classic symptom of intussusception is bloody stool in infants after a crying attack.
3. Vomit- Another typical symptom of intestinal obstruction. The timing of its appearance is the key to the level of the obstacle. Vomiting follows soon after pain if the blockage is in the small intestine, but is delayed if it is in the large intestine. Vomit may have a green color from an admixture of bile or have a fecal appearance.
4. When fully locked the baby's intestines will not allow gas or feces to pass through... However, if the obstruction is only partial, diarrhea may occur.
5. At the onset of the disease no fever.

Complications of obstruction

When the contents in the intestine do not pass the obstacle, the body absorbs a lot of fluid from the intestinal lumen. The abdominal area becomes painful to the touch, the skin on it looks stretched and shiny. Constant vomiting leads the body to dehydration.

An imbalance in fluid disrupts the balance of certain important chemical elements (electrolytes) in the blood, which can cause complications such as irregular heartbeat and, if electrolyte balance is not restored, shock.

Renal failure is a dangerous complication resulting from severe dehydration (dehydration) and / or systemic infection due to intestinal disruption.

Diagnostics

Tests and procedures that are used to diagnose intestinal obstruction:

• physical examination... The doctor will ask about the medical history and symptoms. To assess the situation, he will also conduct a physical examination of the child. The doctor may suspect a bowel obstruction if the baby's belly is swollen or tender, or if a lump is felt in the belly. The doctor will also listen to sounds in the intestines with a stethoscope;
• radiography... To confirm the diagnosis of intestinal obstruction, your doctor may recommend an abdominal x-ray. However, some obstructions in the intestines cannot be seen with standard X-rays;
• CT scan(CT). A CT scan combines a series of X-ray images taken from different angles to produce cross-sectional images. These images are more detailed than standard x-rays and are more likely to show bowel obstruction;
• ultrasound procedure... When intestinal obstruction occurs in children, ultrasound is often the preferred examination;
• air or barium enema... During the procedure, the doctor will inject liquid barium or air into the large intestine through the rectum. For intussusception in children, an air or barium enema may actually fix the problem and no further treatment is needed.

Treatment of intestinal obstruction in children

Children with suspected intestinal obstruction will be hospitalized after an initial diagnostic examination. They will begin to treat immediately in order to avoid pinching the intestinal loops, which can be fatal.

1. The first step in treatment is the insertion of a nasogastric tube to remove the contents of the stomach and intestines.
2. Intravenous fluids will be given to prevent dehydration and correct electrolyte ion imbalances that may have already occurred.
3. In some cases, it is possible to avoid the operation. Volvulus, for example, can be managed with a rectal tube inserted into the intestines.
4. In infants, barium enema can treat intussusception in 50 to 90% of cases.
5. A different, newer contrast agent, a gastrograph, can be used. It is believed to have therapeutic properties as well as the ability to improve bowel scans.
6. Sometimes an air enema is used instead of a barium enema or a gastrograph. This manipulation has been successful in treating partial obstruction in many infants.

Children usually remain in the hospital for observation two to three days after these procedures.

Surgical intervention

Surgical treatment is necessary if other efforts cannot correct or eliminate the blockage.

As a rule, complete obstruction requires surgery, while partial obstruction does not. Restrained areas of the intestine require urgent surgery. The affected area is removed and part of the intestine is excised (bowel resection).

If the obstruction is caused by a tumor, polyps, or scar tissue, they will be surgically removed. Hernias, if present, are repaired to correct the obstruction.

Antibiotics can be given before or after surgery to avoid the threat of infection at the blockage site. Fluid replenishment is done intravenously as needed.

Immediate (urgent) surgery is often the only way to correct a bowel obstruction. As an alternative treatment, a high fiber diet can be recommended to stimulate proper stool formation.

However, common constipation is not the cause of intestinal obstruction.

Forecast

Most types of intestinal obstruction can be corrected with early treatment and the affected child will recover without complications.

Uncontrolled intestinal obstruction can be fatal.

The intestine is either pinched or loses its integrity (perforated), causing massive infection of the body. The recurrence rate is as high as 80% in those for whom volvulus is treated with medication rather than surgery.

Relapses in infants with intussusception usually occur within the first 36 hours after the blockage is cleared. The mortality rate in unsuccessfully treated children is 1 - 2%.

Prophylaxis

Most cases of bowel obstruction cannot be prevented. Surgical removal of tumors or polyps in the intestines helps prevent relapses, although adhesions can form after surgery, further causing obstruction.

Preventing some types of intestinal problems that lead to intestinal obstruction is by ensuring a diet that contains enough fiber to promote normal bowel movements and regular bowel movements.

Preventive nutrition includes:

• Foods high in coarse fiber (whole grain breads and cereals)
• apples and other fresh fruits;
• dried fruits, prunes;
• fresh raw vegetables;
• beans and lentils;
• nuts and seeds.

Diagnosis of intestinal obstruction in a child depends on recognizing related symptoms.

It's important to remember that a healthy diet with plenty of fruits, vegetables, grains, and plenty of water throughout the day will help keep your gut healthy.

Parents should be aware of their child's bowel habits and report cases of constipation, diarrhea, abdominal pain and vomiting to the pediatrician when this occurs.

There are many potential causes of intestinal obstruction. Often this ailment cannot be prevented. Timely diagnosis and treatment are essential. Uncontrolled bowel obstruction can be fatal.

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 is caused by congenital malformations of the intestinal department, motor dysfunction of the organ, growing neoplasms. Pathology requires immediate medical intervention, since there is a high risk of developing serious 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 in the first year of life, the disease is accompanied by severe pain, spasms, and vomiting. In the bulk, surgical tactics are used to eliminate pathology, especially in newborns. Older children are prescribed conservative treatment and diet.

In infants, the disease causes severe spasmodic pains.

Children's intestinal obstruction is a kind of blockage in 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 the chronic form is eliminated with medication, then the acute one - only surgically.

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Classification of intestinal obstruction in children

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

1. By origin, they distinguish between congenital and acquired forms.
2. By the mechanism of education - mechanical, dynamic.
3. According to the characteristics of the symptomatology - complete, partial, acute, chronic.
4. By the nature of the compression of the vessels supplying the intestine with blood, it is strangulated, obstructive, mixed (with adhesions).

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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 abnormalities, therefore, from the first hours, the newborn suffers from severe symptoms of dysfunction. With a particular severity of the course, the baby develops vomiting of bile, bloating. With a mild form of the disease, constipation and vomiting are observed. If this pathology is detected late, the risk of intestinal rupture increases. The manifestations of congenital pathology are stenosis (vasoconstriction, lumen), atresia (fusion of the walls of organs), inflammation. This form is typical for newborns.

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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. The characteristic features of the disease is an unexpected, paroxysmal pain syndrome that turns 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.

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Dynamic

Surges in intra-intestinal 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 abdominal pain, lack of temperature jump, bloating, but vomiting is possible.

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Intestinal obstruction in children is a disease in which the movement of food masses along the tract stops completely or partially. Pathology proceeds in different forms, its symptoms have their own characteristics. With timely referral to a specialist, the prognosis of blockage is favorable.

Why does intestinal obstruction develop?

The mechanism of development of the disease is associated with the appearance of obstacles that do not allow the feces to move normally between the intestines. There are many reasons for the occurrence of stagnation, according to which doctors determine the types of the disease. Intestinal obstruction in children is congenital (diagnosed as atresia, stenosis) or acquired.

In the first case, it is clear that the child is born with a problem. In the second, the disease develops after a while under the influence of various factors, which are divided into functional and mechanical.

The number of mechanical factors is:

• hematomas;
• helminthic invasions;
• intestinal volvulus;
• decrease in the lumen of the intestine;
• abnormal structure of the peritoneum;
• inflammatory processes in the tract, etc.

Mechanical atresia is classified as:

Pediatrician Komarovsky classifies as functional factors such pathological conditions as: spasms and paralytic phenomena, Hirschsprung's disease and disruptions in intestinal motility.

Clinical manifestations of intestinal obstruction

The characteristic symptoms of an acute illness are problems with gas, constipation, vomiting, and abdominal pain. Symptoms such as stool retention and absence of gas, with obstruction of the large intestine, can be observed for several days. If the atresia is small intestine, defecation occurs independently or after the setting of an enema. The absence of gas and feces in the pathology of the small intestine may be its late signs.

Painful sensations in the abdomen are cramping in nature. The attacks coincide with the rhythms of peristalsis, and at these moments the pain becomes intense. The child is worried and tries to find a position of the body that will reduce the discomfort. A strong syndrome gives painful shock.

If intestinal obstruction in children develops in the thin section, the body suffers from profuse repeated vomiting. But emptying the stomach does not bring the long-awaited relief. With stenosis of the colon, vomiting does not often open.

There are also other symptoms that make it easier to diagnose the blockage:

• thirst;
• bloating;
• accelerated contraction of the intestine in the early stages of pathology;
• stopping peristalsis as the disease progresses.

Among all the signs of obstruction, a separate place is occupied by Valya's symptom. This is a swelling of the abdomen, noticeable visually and determined by palpation. The deviation is characterized by asymmetry, stability and preservation of localization.

In newborns and infants, atresia has similar symptoms with minor differences. These include vomiting bile after feeding, bloating in the upper abdomen, grayish skin tone, weight loss due to dehydration, and fever. Symptoms of intestinal obstruction in babies under the age of one year also include moodiness, anxiety, refusal to eat with a previously good appetite and normal behavior.

Methods for diagnosing intestinal obstruction

Atresia is readily apparent on abdominal x-rays. In newborns, the diagnostic measure identifies a "double bladder" with duodenal obstruction, fluid levels with low obstruction, and calcifications resulting from intestinal perforation and meconium ileus. Hirschsprung's disease in newborns is diagnosed by specialists according to the responses of irrigography and intestinal biopsy.

Prenatal diagnosis of intestinal obstruction in future newborn babies is carried out at 16-18 weeks of pregnancy. An anomaly is detected by the expansion of a section of the intestine or stomach of a developing child. Small bowel obstruction is better diagnosed at 24 - 30 weeks, the accuracy of the results of the technique reaches 89%.

In most cases, it is not possible to recognize colonic obstruction in the fetus, since the amniotic fluid is absorbed by the mucous membrane of the tract. An increase in the size of the abdomen and the absence of haustra - areas of protrusion on the colon - are considered important diagnostic criteria.

How is intestinal obstruction treated?

Babies born with signs of intestinal stenosis are operated on by a surgeon. No drug treatment is provided for them. The essence of the intervention consists in excision of the damaged area and the imposition of a colostomy, if the condition is considered severe. With intussusception, resection is dispensed with. The intestines are straightened with air under X-ray control.

Dynamic obstruction, characterized by prolonged tension of the organ or complete relaxation of its walls, is eliminated by medical manipulations:

1. gastric lavage;
2. subcutaneous administration of Proserin;
3. an enema with a hypertonic solution;
4. intravenous administration of a hypertonic solution.

Helminthic invasions are eliminated using cleansing and siphon enemas. For the procedure, use a one percent sodium chloride solution. The intestinal walls, tired from increased peristalsis, are relaxed with antispasmodics.

Dynamic obstruction or paresis of the intestine may result from peritonitis, mechanical trauma to the abdomen, hemorrhage into the mesentery, or reflexively occur.

Symptoms of intestinal obstruction in children

The disease is characterized by a sudden onset, without precursors. usually extremely intense, has a diffuse character, radiates to the epigastric region, often intestinal obstruction, thrombosis or embolism of mesenteric vessels. A distinctive feature of pain is its cramping character: it either grows, acquiring the intensity of intestinal colic, then weakens. Examination of the child allows you to determine the uneven, steadily increasing bloating (flatulence), its asymmetry (Valya's symptom). Sometimes intestinal peristalsis is visible to the eye above the site of the obstruction that has arisen, loud rumbling and transfusion is heard in the intestines at the time of an attack of pain. High tympanitis is determined by percussion. It is important to note that muscle protection ("defense") is initially absent, although abdominal soreness is noted during palpation, more in the circumference of the navel.

An important symptom of intestinal obstruction in children is repeated vomiting, which does not relieve pain; vomit often has a fecal odor.

A frequent, although not an absolute symptom is stool retention (in cases of high obstruction, stool discharge is possible in the first hours). Heart rate and temperature usually remain normal.

Of the auxiliary signs, it can be indicated that a stretched ampulla of the rectum is determined by digital examination.

If the obstruction in children is caused by intestinal intussusception, it is possible to palpate (more often in the ileo-cecal region) a dense tumor-like formation like a sleeve or roller, painful on palpation, above which the intestines are swollen with gases and a splash noise is determined. At the same time, in the feces (if there is stool), an admixture of blood can be detected. Intussusception can be diagnosed by contrast fluoroscopy and intestinal radiography: based on the detection of characteristic "cockade" or "half moon" figures.

When examining the blood picture in cases of intestinal obstruction, neutrophilic leukocytosis with a nuclear shift, often moderate erythracytosis due to blood thickening, is detected. A lot of indican is determined in urine.

Plain fluoroscopy (barium-free) can help identify swollen bowel loops with fluid levels (called Kloyber bowls). The temperature remains normal during the first hours.

Treatment for symptoms of intestinal obstruction

If the symptoms of intestinal obstruction in children confirm the diagnosis, then treatment is carried out in a surgical hospital - an urgent one is needed.

With obstructive and spastic obstruction, if no more than an hour has passed since the beginning of its development, along with preparation for the operation, you can try conservative treatment: subcutaneous administration of atropine, papaverine or no-shpa, which help with functional ileus; massive siphon enemas (temperature - 30-32 °), hypertensive enemas (80-120 ml of 5-10% sodium chloride solution); general warm baths; bilateral perirenal novocaine blockade. In cases of paralytic obstruction, you can test the effect of proserin or physostigmine subcutaneously, isobarine (octadine) sublingually. The question of the operation must be resolved within 2 hours from the onset of the disease. The use of drugs (morphine, omnopon) is undesirable and permissible only during the period of preoperative preparation.

P76.9 Neonatal obstruction, unspecified

Epidemiology

Distribution statistics indicate that intestinal obstruction is a common disease - about 10% of the structure of acute diseases of the abdominal cavity is occupied by this pathology. In 0.1 - 1.6% complicates the course of the postoperative period in sick children who have undergone surgery on the abdominal organs during the neonatal period. Somewhat more often, pathology occurs in boys. Mortality in this pathology ranges from 5 to 30% and strongly depends on the gestation and age of the newborn. In the event of acute intestinal obstruction in the early postoperative period, it reaches 16.2 - 60.3%, and depends on timely diagnosis, the timing of surgical treatment.

Causes of intestinal obstruction in newborns

Intestinal obstruction is a syndrome that complicates the course of many diseases and conditions. The pathophysiological link is a violation of the movement of the chyme along the alimentary canal, which in turn completely or partially disrupts the motor function of the intestine. There can be many reasons for this, but it is the violation of normal bowel function that is one of the most important factors.

To understand all the reasons for the development of obstruction, you need to know some types of this pathology. Distinguish between strangulation, obstructive, spastic and paralytic obstruction. Accordingly, different reasons are shared.

Obstructive obstruction occurs as a result of coprostasis or intestinal tumors, which is much less common in newborns. The cause of coprostasis is congenital Hirschsprung's disease, stenosis of the colon, which are accompanied by intestinal atony. This complicates the contraction and motility of the intestines from the very birth of the baby. This leads to the fact that such children suffer from constipation, and coprolites (small fecal stones) are formed from the feces. Such coprolites can completely obstruct the lumen of the intestinal tube and cause intestinal obstruction.

Strangulated intestinal obstruction develops against the background of Meckel's diverticulum, internal hernias, especially clinically significant hernias of the diaphragm. Such pathologies often lead to increased intestinal motor activity, and especially in newborns, a very mobile intestinal mesentery. This easily leads to constriction of the intestinal wall and some way external strangulation occurs.

The most common causes of intestinal obstruction in newborns are diseases of other organs. They underlie the so-called paralytic obstruction. The reasons may be as follows:

• medicines, especially narcotic drugs, that affect the muscular wall of the intestine;
• an infection of the abdominal cavity impairs not only motor skills, but also other functions of the intestine;
• mesenteric ischemia against the background of congenital vascular pathologies of the descending aorta or mesenteric arteries;
• complications of abdominal surgery;
• diseases of the kidneys and organs of the chest cavity;
• metabolic disorders (hypokalemia);
• necrotizing enterocolitis in newborns;

Often such obstruction occurs against the background of birth trauma, functional immaturity of the digestive tract, pneumonia, sepsis, and peritonitis. These pathologies cause a reaction of internal organs in the form of centralization of blood circulation, which causes ischemia of the intestinal wall. It is also disturbed against the background of peristalsis intoxication, especially in newborns against the background of immaturity of the mechanisms for coordinating this function. This leads to paresis of the intestine and the development of further obstruction.

Separately, intussusception is distinguished, since with this option of obstruction there are elements of obturation and strangulation. Intussusception is a special type of acquired obstruction in young children, the essence of which is that the proximal segment of the intestine wedges into the distal one. In the future, the blood supply to the intestine is disrupted, which leads to its necrosis.

Distinguish between small intestinal intussusception, ileocecal type (90%), very rarely colonic (1-3%) intussusception. In the area where intussusception has occurred, a tumor-like formation is formed, which consists of three layers of the intestinal wall: external, into which the invaginate is wedged, middle and internal. Between these walls of the invaginate, the mesentery of the intestine is pinched. The clinical course of the disease depends on the degree of pinching - with slight infringement, the symptoms of the obstructive process prevail, the disease proceeds easily, intestinal necrosis does not occur. In cases of severe infringement, signs of strangulated intestinal obstruction prevail, bloody feces and necrosis of invaginate rapidly appear. Ileocecal intussusception proceeds more easily than small intestine. After the phase of venous stasis, as a rule, edema rapidly increases, stagnant bleeding occurs, and a bloody effusion appears in the abdominal cavity. In connection with a progressive disturbance of the blood supply, necrosis of the invaginate occurs.

Pathogenesis

The pathogenesis of changes in obstruction does not depend on its type, but depends on the local stopping of the movement of food through the intestines. This causes further changes that underlie the development of symptoms.

In the area of ​​the pathological source in the intestine, the integrity and permeability of the blood vessels and the peritoneum itself is disrupted, providing ultrafiltration of plasma and tissue fluid. This leads to the fact that plasma proteins containing inactive components of the blood coagulation system go outside the vascular bed and peritoneum into the abdominal cavity. These substances, upon contact with the damaged peritoneum and tissues of the abdominal organs, are activated, a cascade coagulation reaction occurs, which ends with the loss of fibrin on the surface of the abdominal organs. This is facilitated by tissue coagulation factors contained in the cells of the tissues of the abdominal organs and peritoneal mesothelium. Fibrin deposited on the surface of the abdominal organs has adhesive properties and fixes adjacent organs. This leads to the fact that in the place where the food stopped, gluing of the layers of the intestine, as well as the mesentery, occurs even more. This completely disrupts the movement of the chyme and is the main mechanism of the pathogenesis of intestinal obstruction in the newborn.

Symptoms of Bowel Obstruction in Newborns

Symptoms of intestinal obstruction in newborns do not depend on the species, since the pathogenetic features of the course of the pathology do not have any special differences. The stages of development of disorders in intestinal obstruction pass sequentially from circulatory disorders of a certain part of the intestine to its necrosis. Considering that in newborns the intestinal wall is very thin, then the period for the development of symptoms is reduced. When intestinal necrosis occurs, the whole process ends with peritonitis.

The first signs of acute intestinal obstruction begin suddenly and are characterized by a large polymorphism of clinical manifestations. The process quickly leads to severe intoxication, changes in homeostasis, causes various complications of the pathological process and worsens the patient's condition.

The classic clinical picture of intestinal obstruction in a newborn is characterized by a sudden onset against the background of complete health. Gradually there is pain in the intestines, which is characterized by bouts of anxiety in newborns with a gradual addition of toxicosis phenomena.

Vomiting is one of the obligatory symptoms of this disease in newborns. With high intestinal obstruction, vomiting appears on the first day of life after birth. Depending on the level of the lesion, the nature of the vomiting may vary.

So, in conditions of complete obstruction, vomit will look like curdled milk without bile impurities. If the process is localized slightly lower at the level of the distal small intestine, then vomiting will be digested milk.

The nature of the feces of the newborn also changes. With high obstruction, almost ordinary meconium will go away, normal in quantity and color. If the process of obstruction is slightly lower, then the meconium is practically not colored. There may also be bloody discharge from the rectum or streaks of blood in the baby's stool.

The general condition of newborns from the onset of the disease is satisfactory, but quickly

exicosis and hypotrophy phenomena progresses against the background of repeated vomiting and diarrhea. There is dryness of the skin, retraction of the eyes, fontanelle, a decrease in tissue turgor. Later, there is a swelling of the epigastrium, which decreases after vomiting.

The clinical picture of paralytic intestinal obstruction is characterized by a sharp bloating, intoxication, stool and gas retention. Since the paralytic focus is wider than with other types of obstruction, the bloating of the child's tummy is very pronounced. This can disrupt the breathing process, which in turn is a prerequisite for the development of hypoxia and hypostatic pneumonia.

The body temperature does not often rise, the phenomena of intoxication are often accompanied by dehydration and electrolyte disturbances.

Congenital bowel obstruction in a newborn has the same manifestations, but they appear immediately after the birth of the child. Vomiting, impaired discharge of meconium, bloating - all these symptoms begin to appear within a few hours after birth.

Partial intestinal obstruction in a newborn is characterized by disorders in which the intestinal cavity is only half closed. Therefore, symptoms do not develop so acutely and must be carefully differentiated from functional disorders in newborns.

Complications and consequences

The consequences and complications of bowel obstruction can be very serious. Considering intestinal necrosis in the absence of timely treatment, one of the most frequent consequences is peritonitis. More distant consequences can develop if surgical treatment was performed. In this case, dense adhesions are often formed, which can lead to repeated obstruction in the future. Persistent functional disorders of the intestine in children in the future is one of the frequent consequences of the transferred intestinal obstruction. In the presence of other concomitant pathologies in newborns with obstruction, the risk of mortality increases, including lethal complications.

Diagnosis of intestinal obstruction in newborns

Diagnosis of intestinal obstruction in newborns must necessarily be based on a thorough examination of the baby. After all, vomiting and stool disorders are nonspecific symptoms that are characteristic not only of intestinal obstruction.

It is imperative to examine the belly of a newborn child if any intestinal pathology is suspected.

With intussusception against the background of intestinal manifestations, there are other local symptoms. A tumor-like formation of a doughy consistency is palpated, which, when pressed, can change its position. With paralytic obstruction, the abdomen looks sharply inflated, on palpation it is soft. Percussion reveals high tympanitis, auscultatory - peristaltic noises are not heard. The normal motor process is impaired, so no noise is detected.

The analyzes that are necessary for the diagnosis of obstruction are not specific, therefore, at the initial stages, they are limited only to general analyzes.

Instrumental diagnostics is the main and priority method for confirming the diagnosis of obstruction. X-ray examination allows you to determine the level of obstruction and the degree, because above the level of the obstruction, gases and food accumulate, and below there are no signs of normal motor skills. X-ray examination helps to verify the changes characteristic of high intestinal obstruction: a pronounced accumulation of air in the upper parts of the intestine and determining the level of fluid under these gases. The bowel loops are positioned in such a way that they form "arcades" that look like garlands filled with half air and half liquid. The normal intestine has a clear distribution and location of the loops.

Differential diagnosis

Differential diagnosis should be carried out with congenital intestinal anomalies, esophageal atresia, pyloric stenosis. All these pathologies are symptomatically very similar, but with a careful examination, the diagnosis can be determined.

Treatment of intestinal obstruction in newborns

If an intestinal obstruction is suspected, it is mandatory to treat the child in a hospital. Therefore, with the appearance of repeated vomiting, a violation of the stool, it is imperative to hospitalize the newborn if he was at home before. If a newborn has similar problems immediately after birth, then it is imperative to consult a surgeon.

During the first 1.5-2 hours after the child is admitted to the hospital, complex conservative therapy is carried out. Such treatment has a differential diagnostic value and, by its nature, can be a preoperative preparation.

The therapy is aimed at preventing complications associated with pain shock, correcting homeostasis and at the same time is an attempt to eliminate intestinal obstruction by non-operative methods.

1. Measures aimed at combating abdominal pain shock include: neuroleptanalgesia (droperidol, fentanyl), paranephral novocaine blockade and the administration of antispasmodics (baralgin, spazmoverin, spasfon, no-shpa). In children, the use of some funds may be limited during the neonatal period, therefore, treatment is carried out with the obligatory consultation of a pediatric anesthesiologist. Pain relief is carried out after the diagnosis has been made.
2. The elimination of hypovolemia with the correction of electrolyte, carbohydrate and protein metabolism is achieved by the introduction of saline blood substitutes, 5-10% glucose solution, gelatin, albumin and blood plasma. All calculations are carried out taking into account the needs of the body of a newborn child in fluid, and besides this, the needs for nutrients are also taken into account.
3. Correction of hemodynamic parameters, microcirculation and detoxification therapy is carried out using intravenous infusion of rheopolyglucin, reogluman or neohemodesis.
4. Decompression of the gastrointestinal tract is performed using a nasogastric tube. A child with a confirmed diagnosis of intestinal obstruction should be transferred to total parenteral nutrition. Feeding the child is prohibited and all substances are calculated by body weight. At the time of treatment, enteral nutrition is completely prohibited; from the moment of recovery, breastfeeding is gradually introduced.
5. When treating paralytic obstruction, it is necessary to treat the underlying disease that caused the paresis. In addition, they carry out drug stimulation of intestinal motility with proserin, infusion solutions.

When there is obstruction, then gradual necrosis with absorption of decay products and intoxication necessarily occurs in this part of the intestine. This is always a prerequisite for the multiplication of bacteria, therefore, regardless of the method of treatment, antibiotic therapy is used for intestinal obstruction. Only spastic and paralytic obstruction is treated with conservative methods for several hours. All other types of obstruction should be treated with surgery without delay. In this case, an initial antibacterial, infusion therapy is carried out for two to three hours, which is a preoperative preparation.

1. Sulbactomax is a combined antibiotic that consists of 3 generation cephalosporin ceftriaxone and sulbactam. This composition leads to the fact that the antibiotic becomes more resistant and is not destroyed by bacteria. It is used for treatment in combination with other drugs. The route of administration is intravenous for faster action. The dosage of the drug is 100 milligrams per kilogram of body weight. Side effects are in the form of allergic reactions, impaired renal function, effects on the liver.
2. Kanamycin is an antibiotic from the macrolide group, which is used for newborns in the treatment of intestinal obstruction both preoperatively and in the postoperative period to prevent complications. The dosage of the drug is 15 milligrams per kilogram of body weight per day for the first three days, then the dose can be reduced to 10 milligrams. Method of application - intravenous or intramuscular, divided into 2 doses. Side effects can be in the form of irreversible hearing impairment, as well as toxic effects on the kidneys.

When the child's condition is stabilized, a mandatory surgical intervention is performed. Surgical treatment of intestinal obstruction is mandatory with obstructive and strangulation type. Since with these types there is a mechanical obstacle, it will not be possible to restore normal bowel function only with medication.