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Virtual Pediatric Hospital: Paediapaedia: Approach to Obstruction in the Neonate Paediapaedia: Gastrointestinal Clinical and Radiographic Presentations, DDX, Approach to Imaging

Approach to Obstruction in the Neonate

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


DDX:

Approach/Discussion:
The clinical presentation of high obstruction is early bilious vomiting and limited abdominal distension. The clinical presentation of low obstruction is late bilious vomiting and generalized abdominal distension.

A high bowel obstruction will have a few dilated loops of small bowel in the abdomen. A low bowel obstruction will have multiple loops of dilated small bowel in the abdomen. Differentiation between large and small bowel in the neonate is difficult since mucosal landmarks such as valvuli, plicae, and haustra are poorly developed and effaced.

A complete obstruction allows no gas beyond it, a partial obstruction allows some gas beyond it.

The imaging workup should be directed at determining the (1) presence and degree, (2) level, and (3) cause of the obstruction. (1) and (2) can be determined by the plain film, while (3) is determined by a GI contrast study - an upper GI in a high obstruction and an enema in a low obstruction.

References:
See References Chapter.

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