Intestinal Obstruction

Regurgitation, diarrhea and constipation are fairly common in infants. When these problems occur with abnormal frequency, however, they may be signs of intestinal obstruction, a serious condition in which a blockage develops in the stomach, small intestine or large intestine. Such an obstruction may be present at birth or develop later in infancy or during early childhood.

HOW DOES INTESTINAL OBSTRUCTION DEVELOP?

Intestinal obstruction can develop in several different ways. An infant may be born with a congenital intestinal malformation that causes narrowing or twisting of a section of the small or large bowel. Pyloric stenosis, in which the passage between the stomach and small intestine fails to open properly, is the most common intestinal obstruction in infants. Newborns with a condition called Hirschsprung disease typically develop obstruction of the large intestine because they lack certain nerves that control function of the large intestine. The result is a greatly enlarged colon and severe constipation. Affected infants may also get sudden high fever and rectal bleeding. About ten percent of babies born with cystic fibrosis have intestinal obstruction caused by retention of meconium, the greenish-black substance that fills the colon before birth.

In the first two years of life, one of the major causes of intestinal obstruction is intussusception, in which one portion of the intestines is pushed into another like a folding telescope. Another possible cause is an inguinal hernia, in which a segment of intestine protrudes through the abdominal lining into the groin.

Unless corrected, intestinal obstructions can severely compromise a baby's or child's nutrition and fluid balance. Ultimately, the area above the obstruction may rupture, allowing intestinal contents to spill into the abdominal cavity and resulting in peritonitis, a serious infection.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS INTESTINAL OBSTRUCTION?
The pediatrician or hospital nursery staff will notice if the baby fails to pass meconium within 12 to 24 hours after birth. Failure to pass meconium strongly suggests the presence of an intestinal obstruction. Other symptoms in the newborn include vomiting and abdominal bloating.

In older children, the major symptom of intestinal obstruction is abdominal pain, which may be either sharp or dull. If the child cannot yet talk, signs of abdominal pain may include grimacing and pulling up the legs. Other signs of intestinal obstruction in older children include nausea, repeated vomiting, abdominal bloating and constipation.

IS MEDICAL ATTENTION NECESSARY?
Yes. The signs and symptoms of intestinal obstruction warrant immediate medical care.

HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS AN INTESTINAL OBSTRUCTION?
If the obstruction is caused by a hernia or pyloric stenosis, the pediatrician may be able to make the diagnosis on the basis of a physical and ultrasound examination. X rays of the intestinal tract, taken after the contrast material barium is swallowed (or placed in the stomach through a tube) or administered as an enema, can help locate the site of the obstruction.

WHAT TREATMENTS ARE AVAILABLE?
If the doctor suspects an intestinal obstruction, the child will be hospitalized and seen immediately by a surgeon. In most cases, surgery in necessary to remove the obstruction, although a twisted intestine occasionally returns to normal without surgery.

GETTING HELP
Call your doctor if your child:

• Fails to pass meconium (greenish-black fecal matter) within 12 to 24 hours after birth

• Is grimacing and pulling up the legs, indicating abdominal pain, or complains of stomach pain, particularly in conjunction with vomiting, abdominal bloating and constipation

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.