Makindo Medical Notes

Intussusception is the most common cause of intestinal obstruction in children under 2 years of age.

About

• Leading cause of intestinal obstruction in young children.
• Can cause severe abdominal symptoms, requiring prompt diagnosis and treatment.

Aetiology

• Multiple underlying causes, including congenital anomalies, infectious processes, and other mechanical obstructions.

Clinical Features

• Vomiting, often bilious in nature.
• Severe abdominal pain, sometimes intermittent or colicky.
• Absolute constipation (no passage of stool or flatus).
• Abdominal distension with high-pitched or absent bowel sounds.
• Characteristic “currant jelly” stools in cases of intussusception.

Causes of Intestinal Obstruction in Children

Cause	Clinical Features	Diagnosis	Management
Congenital Anomalies	Abdominal distension, vomiting, feeding intolerance, failure to pass meconium.	Abdominal X-ray, ultrasound, contrast studies.	Typically requires surgical intervention depending on the specific anomaly.
Intussusception	Abdominal pain, “currant jelly” stools, vomiting, abdominal mass.	Abdominal ultrasound, CT scan.	Air contrast enema (therapeutic and diagnostic), surgical intervention if needed.
Hernia	Visible lump in the groin or umbilicus, abdominal pain, vomiting.	Clinical examination, ultrasound if needed.	Manual reduction, surgical repair.
Adhesions	Abdominal pain, bloating, vomiting, previous abdominal surgery history.	Abdominal X-ray, CT scan.	Surgical intervention to release adhesions if conservative measures fail.
Malrotation	Abdominal pain, bilious vomiting, distension, possible shock.	Abdominal X-ray, upper gastrointestinal series.	Surgical correction and fixation of the bowel.

Causes of Ileus in Children

Cause	Clinical Features	Diagnosis	Management
Postoperative Ileus	Abdominal bloating, decreased bowel sounds, nausea, vomiting.	Abdominal X-ray, CT scan to rule out obstruction.	Supportive care, including bowel rest, IV fluids, and gradual reintroduction of oral intake.
Functional Ileus	Similar to postoperative ileus; often related to underlying systemic condition.	Clinical examination, imaging to exclude mechanical obstruction.	Address underlying cause, supportive care, hydration, and bowel rest.
Infectious Causes	Abdominal pain, fever, vomiting, diarrhoea or constipation.	Clinical examination, stool tests, imaging if needed.	Treatment of the underlying infection (antibiotics or antivirals as appropriate).
Electrolyte Imbalance	Abdominal distension, nausea, vomiting, possible mental status changes.	Serum electrolyte levels, clinical assessment.	Correction of electrolyte imbalance, supportive care.
Medication Effects	Abdominal pain, nausea, constipation or diarrhoea, depending on the medication.	Clinical history, review of current medications.	Adjust or discontinue the offending medication, supportive care.

Investigations

• Blood tests: FBC, U&E, CRP to assess general health and potential infection or inflammation.
• Abdominal X-ray: To assess for distended bowel loops and absence of air in the rectum, suggestive of obstruction.
• Ultrasound: For diagnosis of specific conditions like intussusception (target or doughnut sign).

Pathology

• Pathology varies with cause, ranging from mechanical blockages (e.g., intussusception, malrotation) to functional issues (e.g., ileus).

Management

• Paediatric surgical referral for definitive management of underlying cause.
• Nil by mouth, IV fluids, and electrolyte correction. Close monitoring for signs of deterioration.
• For intussusception specifically: therapeutic air contrast enema, which may reduce the intussusception and provide diagnostic clarity.

References

• Intussusception in Children - UpToDate
• Intestinal Obstruction in Children: Overview and Management - NCBI