Physical obstruction prevents the flow of faeces through the intestine; causes absolute constipation and leads to backpressure through the GI system which causes vomiting

Aetiology

Causes of intestinal obstruction

• Malrotation of the intestines with midgut volvulus
  • Volvulus: loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction
  • Malrotation: congenital anatomical anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis
    • Up to 40% of patients with malrotation show signs within the first week of life
    • 50-60% diagnosed by 1 month and 75% diagnosed by age 1
• Meconium ileus can predispose to segmental volvulus
• Hirschsprung’s disease
• Oesophageal atresia
• Duodenal atresia
• Intussusception
• Imperforate anus
• Strangulated hernia

Clinical features

• Persistent vomiting
  • This may be bilious, containing bright green bile

• Abdominal pain and distention
• Failure to pass stools or wind
• Abnormal bowel sounds - can be high pitched and tinkling’ early in the obstruction and absent later

Investigations

• Abdominal x-ray
  • May show dilated loops of bowel proximal to the obstruction and collapsed loops of bowel distal to the obstruction
  • There will also be absence of air in the rectum

Management