Parents have been familiar with tummy problems since the birth of their baby. The first pain is usually associated with colic, dysbiosis or short-term intestinal spasms. But it is necessary to find out the reason. Intestinal obstruction in children, especially newborns, can lead to serious health problems. Therefore, it is important to know what symptoms accompany the disease, what causes it, and which doctor to contact if you suspect an obstruction.
Description of the pathology
Intestinal obstruction in children is a pathology associated with a failure in the process of pushing chyme (broken down food with digestive juice) through the lumen. In babies of the first year of life, the disease is accompanied by severe pain, cramps, and vomiting. Most people use surgical tactics to eliminate pathology, especially in newborns.
Older children are prescribed conservative treatment and diet. In infants, the disease causes severe cramping pain.
Children's intestinal obstruction is a kind of blockage of the lumen. The complexity and severity of the disease depends on the location of the problem - the higher the blockage occurs, the more severe the disease will be. The peculiarity 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 form can only be eliminated surgically.
Classification of intestinal obstruction in children
Intestinal obstruction in newborns and older patients is classified according to genetics, anatomical-physiological, and symptomatic parameters. Correctly determining the type of blockage allows you to prescribe adequate treatment and adjust the intensity of the measures taken. International classification:
- Based on origin, a distinction is made between congenital and acquired forms.
- According to the mechanism of formation - mechanical, dynamic.
- According to the characteristics of the symptoms - complete, partial, acute, chronic.
- According to the nature of compression of the vessels supplying the intestine with blood - strangulation, obstruction, 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 development abnormalities, so the newborn suffers from severe symptoms of dysfunction from the first hours. When the disease is particularly severe, the baby develops vomiting of bile and bloating. In mild forms of the disease, constipation and vomiting are observed. If this pathology is detected late, the risk of intestinal rupture increases. Manifestations of congenital pathology are stenosis (narrowing of blood vessels, lumen), atresia (fusion of organ walls), and inflammation. This form is typical for newborns.
Acquired
Pathology is provoked by external or internal unfavorable factors. It most often develops in infants aged from 4 months to a year in the form of intussusception (penetration of one part of the intestine from another) or a mechanical disorder. Adhesions are formed quite rarely. The characteristic features of the disease are an unexpected, paroxysmal pain syndrome that progresses to vomiting, and blood and mucus are found in the stool. A 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
Jumps in intestinal pressure provoke peritonitis. The development of this form is provoked by weakening of the regional blood supply to the mesentery, disruption of water and electrolyte balance, and dysfunction of the central nervous system departments responsible for correcting the functioning of the gastrointestinal tract. As a result, inflammation develops. The incidence is 10% of all recorded 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 intestinal rupture and peritonitis;
- spastic pathologies, characterized by excessive muscle tension, paroxysmal abdominal pain, absence of a jump in temperature, 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 the abdominal cavity. Depending on the causative factors, there are the following subforms:
- adhesive, formed against the background of adhesion;
- obstructive, formed when the intestinal lumen is compressed by tumor tissue, foreign bodies, parasites, or blockages with food bolus, but without compression of the mesenteric vessels.
Why is this happening?
Most often, constipation in newborns is caused by pinching or volvulus of the intestine (intussusception). Moreover, according to statistics, boys aged six months and older are more susceptible to this phenomenon than girls. The causes of volvulus are:
- physiological disturbances in peristalsis, which are typical in the first year of life;
- immaturity of the digestive system, excessive mobility of the colon;
- increased density feces;
- worms in the child’s body - in this case, the obstruction is accompanied by spasms, and therefore, during treatment, they are removed first.
This problem can also be caused by the formation of a tumor in the intestine. This is practically impossible if the baby experiences constipation just once. And vice versa: if the blockage recurs quite often, it is necessary to conduct an examination to confirm or refute the presence of a tumor.
It is difficult to meet a child who has never had a similar situation in the first 12 months of life: if the mother does not adhere to the diet, if the formula is poorly chosen, if complementary feeding begins - in all these cases the body can react with the appearance of such a problem.
Causes
What are the causes of intestinal obstruction? As mentioned earlier, in most cases it is not possible to identify the main cause of this pathology. However, all possible factors in the development of the pathological process are divided into two groups: mechanical, as well as nutritional, that is, related to food consumption.
As for children aged 0 to 3 years, in this case the characteristic nutritional factors for the development of intussusception or intestinal obstruction will be characteristic. The ICD-10 code is K-56. Mechanical factors are typical for older children.
It is believed that the following factors may trigger the development of the disease in children:
- Incorrect schedule for introducing complementary foods into the diet.
- Unstable power supply.
- Food too thick.
- Food is chunky or coarse.
Nutritional factors in the development of the disease are also typical for the adult part of patients. Sometimes people with symptoms of this disease come to the clinic after eating their usual food, for example, dumplings, dumplings, black bread. Patients often associated the development of intussusception with quick snacks when they swallowed unchewed pieces.
In addition, a special role in the development of the disease among adults is given to mechanical factors, which include cystic formations, polypous growths of the intestine, Meckel's diverticula, which is a congenital protrusion of the walls of the ileum, diseases of the pancreas, intestinal tumors, both malignant and benign.
In addition, there are factors that do not directly lead to intestinal disease, but increase the risk of developing intussusception. These include the intestinal form of allergy, cystic fibrosis, impaired motor activity, conditions after various surgical interventions on the gastrointestinal tract, intestinal viral infections, family history, male gender. If you go to the hospital, do not forget that the ICD-10 code for intestinal obstruction is K56.
Quite often, intussusception can be a complication of specific diseases and conditions, which include bacterial and viral damage to the intestines, chronic, acute exacerbation of chronic inflammation of the mucous membranes in any part of the gastrointestinal tract, for example, enteritis, gastritis, colitis, other ailments of the large and small intestines , peritoneal tuberculosis, intestinal tuberculosis, enteroptosis. It is these ailments that are considered the causes of intestinal obstruction.
What is the surgical procedure?
For any type of congenital intestinal obstruction, the operation is aimed at restoring the free passage of food through the intestine. Surgery can be performed in different ways, that is, surgery depends on the purpose of the intervention
The condition of the damaged area of the intestine is of particular importance. The surgeon evaluates its viability, and if it is in doubt, a section of the intestine is removed and the remaining ends are connected by anastomosis.
If a volvulus or intussusception occurs in the intestine, the surgeon can leave it intact and straighten the intestines only if no more than 4 hours have passed since the illness. If intussusception lasts longer, a section of the intestine dies and surgery—resection—is required.
When peritonitis develops in an infant, the abdominal cavity is thoroughly washed and all parts of the intestine are examined to identify symptoms of damage. Drains are installed in the abdominal cavity to drain the contents.
After all the necessary stages of the operation have been completed, the abdominal cavity is sutured and an aseptic dressing is applied.
Stage-by-stage development
The onset of the disease is characterized by strong rumbling in the abdomen. Intestinal obstruction in newborns and older children develops in 3 stages:
- The first, initial stage lasts 3-12 hours. Characteristic symptoms are abdominal pain, strong rumbling, flatulence.
- The intermediate stage is 13-36 hours. During this period, the baby shows signs of imaginary improvement, which characterizes the beginning of intoxication of the body with partial loss of fluid.
- The last, terminal stage overtakes the baby with a sharp increase in symptoms and damage to other organs.
Varieties of the disease
Intestinal obstruction can be:
- chronic;
- one-time
In the chronic version, parents already clearly know the procedure. But if the obstruction becomes of this nature (there is no stool for two or three days in a row or the child cannot poop without outside help during the same time), you should definitely tell the doctor about it. You may need to undergo treatment to address the root of the problem, and not just the main symptom. And the sooner, the better.
Symptoms
Each of the listed types of intestinal obstruction in infants and older children has characteristic symptoms, but there are common signs of pathology, such as:
Damage to the small intestine is provoked by repeated vomiting. Pain syndrome. The sensations are cramping and often coincide with the rhythms of peristalsis. During an attack, the pain intensifies to the point of shock. Changing body position does not bring relief.
- Vomiting reflex. The symptom occurs repeatedly and abundantly, does not bring relief if the small intestine is affected. If the functioning of the colon area is disrupted, vomiting is not so frequent.
- Constipation, accumulation of gases in the lumen. If the patency of the colon is impaired, gases and stool may not pass for up to several days. If there are problems with the small intestine, then defecation is possible on its own or with an enema. But if this does not happen, then the symptom indicates the terminal stage of the process.
- Additional signs by which one can understand that patency is impaired are thirst, bloating, hyperactivity of intestinal peristalsis, turning into atony (complete relaxation of motor skills).
Carrying out diagnostics
The complaints that come from a patient with this disease cannot be called characteristic only of this disease, therefore, to confirm the diagnosis, instrumental, physical, and laboratory tests should be carried out. A physical examination involves inspection, tapping, palpating, and examination with an endoscope.
During the examination, the following signs are revealed:
- At the initial stage of development of the disease, the tongue is normal, but then a white coating appears on it.
- The abdomen is swollen, the front walls are tense. This sign indicates that intestinal obstruction is developing.
To confirm the diagnosis, instrumental methods are also used, which include fluoroscopy, radiography with contrast, ultrasound, and computed tomography. The specialist also examines a general blood test and stool under a microscope.
Revealing
If you notice the first symptoms of the disease in a child, you should immediately seek medical help, because in the case of an acute course, late diagnosis is fraught with complications and even the death of the baby.
The diagnostic tactics used by the doctor are as follows:
- Questioning, examination, palpation of the child’s abdomen to identify the clinical picture.
- X-ray examination. It can be carried out with barium contrast, air injection - to determine the places of narrowing, fusion, shortening or lengthening of the sigma.
- Laparoscopy. Used in emergency cases - intestinal volvulus, adhesive obstruction.
- Ultrasound is an auxiliary examination method.
Total information
Intussusception is most often observed (in 90% of all clinical cases) in infants. The peak incidence falls at 5-7 months of age, when complementary foods begin to be introduced into the child’s diet - the intestines are not always able to adequately “rebuild” and instantly adapt to new food. There are 3-4 cases of intussusception per 1000 infants; it occurs more often in boys.
At a young age, they suffer quite rarely, then the incidence increases in the older age group (mainly from 45 to 60 years).
Treatment
In case of complications, small patients undergo surgery. For the treatment of intestinal obstruction, newborns, infants and older patients are sent to the surgical department. Until an accurate diagnosis is made and the form of the disease is determined, enemas, taking laxatives, and flushing the gastrointestinal tract are prohibited. In complicated cases, surgery is indicated. Acute conditions require taking measures to relieve pain, cleansing the intestines with an enema, intensive treatment, and taking measures aimed at improving water-salt balance.
Intended therapy
Treatment of any type of congenital intestinal obstruction - high or low - consists of surgical intervention in children. Treatment should be carried out immediately after the diagnosis of congenital intestinal obstruction. Before the operation, a short pediatric preoperative preparation is prescribed. It is also different for different types of obstruction.
In case of high congenital intestinal obstruction, preoperative preparation takes no more than six hours. It consists of the following activities:
- Providing the child with optimal temperature conditions.
- After repeated vomiting, correction of the water-salt balance is required.
- A venous catheter is installed for infusion therapy.
- The stomach is emptied and a tube is inserted into it.
- Treatment with drugs to support blood circulation and breathing is prescribed.
After preparation, the child is taken to the operating room for surgical treatment of congenital high obstruction.
Preparation for low congenital intestinal obstruction may vary depending on the severity of the condition. If the diagnosis was made early, then it is possible to carry out full preparation according to the same principles as for high obstruction.
If congenital obstruction was discovered after 2-3 days, there is a high probability of complications. In this case, preoperative preparation is minimal, no more than two hours are allocated for it - emergency surgery is required.
The preparation activities are as follows:
- Placement of a venous catheter and initiation of infusion therapy.
- Cleansing the stomach cavity and inserting a tube.
- Prescribing medications to maintain the activity of the heart and lungs.
Immediately after a short preparation, surgical treatment is carried out.
Prevention
Everyone knows that it is easier to prevent any disease than to treat it later. Moreover, if we are talking about such an unpleasant illness as intussusception, which almost always requires surgical treatment. As a preventive measure, it is necessary to introduce complementary foods to children according to the schedule. This means that the first foods are introduced into the diet no earlier than the baby is six months old. The appearance of new dishes on the menu should be gradual. The amount of food consumed should gradually increase. It is best to use pureed dishes made from one component for complementary feeding.
As for prevention in adults, they need to follow their diet and diet, and exclude too rough foods from their daily menu. In addition, you should chew food thoroughly during lunch or dinner. Another mandatory preventive measure is the timely diagnosis and treatment of tumors in the intestinal area.
How to help a newborn?
Firstly, it is necessary to reconsider the drinking regime. If the baby is fully breastfed and it is not summer outside, does it need to be supplemented with water? Definitely not. Mother’s milk already consists primarily of water, so the newborn is not at risk of dehydration and the formation of hard feces in this case. Moreover, pediatricians are sure that if such a baby is supplemented with water, he will eat less milk, which means he will receive less vitamins and minerals that he needs so much for normal development.
But if the air temperature is high, if the baby is bottle- or mixed-fed, if he is already getting acquainted with adult food, he needs water. It softens feces, facilitating their movement in the intestines, so that the act of defecation does not cause discomfort to the baby.
Secondly, you need to have an enema in your home medicine cabinet. It is important to remember that an enema for newborns is not a standard hygienic measure, but a therapeutic procedure, so you should not resort to its help too often. But in acute cases it is very useful. Before use, the enema must be boiled, and also prepared for filling with either ordinary water (boiled and cooled to room temperature - not cold!), or a mixture of water and chamomile infusion, or a mixture of water and a teaspoon of vegetable oil. In order not to injure the delicate baby skin, the edge of the tip is lubricated with Vaseline or baby cream and, after releasing the air, the crumbs are slowly introduced into the anus - not deep, no more than 1.5 cm. Then the water is sprayed out, and the baby’s buttocks are tightly squeezed 30 seconds is enough time for the enema to take effect.
Often it is not worth using such a method as an enema for a newborn, since an enema with water also washes away the beneficial intestinal microflora. In addition, a large amount of water in this organ increases the absorption of the walls of the colon, which means that the body will “accept” more toxins.
If parents are not sure that they will be able to give their newborn baby an enema correctly, there is an easier way to help with constipation: you can use a glycerin suppository. The fact is that inserting a suppository into the anus also irritates the intestines and stimulates the movement of feces.
But when a newborn is often helped to get rid of constipation by such physical intervention in the body’s functioning, this “relaxes” the intestines. As a result, some children are then unable to go on their own - they only need help in the form of an enema or a suppository. That is why such measures should be resorted to only as a last resort. A balanced diet, tummy massage and drinking regime will help make these cases as rare as possible.
Classification of dynamic intestinal obstruction
In medicine, each diagnosis has its own individual code, name and generally accepted standards of medical care. A disease such as dynamic intestinal obstruction is no exception. ICD 10 (International Classification of Diseases) classifies the disease in question as follows:
- class XI “Diseases of the digestive organs” (K00-K93);
- section “Other intestinal diseases” (K55-K63);
- diagnosis code – K56.6;
- title: “Other and unspecified intestinal obstruction.”
In medical practice, it is customary to distinguish between two main types of dynamic intestinal obstruction:
