Causes Of Bowel Obstruction In Children

Question 1

What are the main categories for causes of bowel obstruction in children?

Answer 1

The causes of bowel obstruction in children can be divided into:
• Congenital
• Acquired
• Functional

Question 2

What are some congenital causes of bowel obstruction in children?

Answer 2

• Bowel atresia and stenosis
• Meconium ileus
• Anorectal malformation
• Duplication cysts
• Volvulus
• Intraperitoneal bands

Question 3

What are some acquired causes of bowel obstruction in children?

Answer 3

• Necrotizing enterocolitis (NEC)
• Intussusception
• Hypertrophic pyloric stenosis
• Faecaloma/Bezoar/Worms
• Peritonitis
• Post-operative adhesions
• Incarcerated hernias
• Malignancies
• Inflammatory bowel disease
• Tuberculosis

Question 4

What are some functional causes of bowel obstruction in children?

Answer 4

• Hirschsprung’s disease
• Meconium plug syndrome
• Ileus

Question 5

What is the most common intestinal worm to cause surgical complications in coastal South Africa?

Answer 5

Ascaris lumbricoides.

Question 7

What percentage of the world’s population is estimated to be infested with Ascaris lumbricoides?

Answer 7

20%.

Question 8

Before routine deworming in South Africa, what percentage of children presenting to hospitals had worm eggs in their stool?

Answer 8

70%.

Question 9

What are the possible clinical problems related to ascariasis?

Answer 9

1. Worm bolus intestinal obstruction
   
   2. Worms in the biliary tree
   3. Acute appendicitis
   4. Acute pancreatitis
   5. Peritonitis

Question 10

How does a child with a worm bolus intestinal obstruction typically present?

Answer 10

With a history of colicky abdominal pain (96%), tenderness on palpation (80%), vomiting (bilious ± worms), and possibly a palpable abdominal mass.

Question 11

What nutritional status is commonly seen in children with worm bolus obstruction?

Answer 11

They are generally malnourished, with 55% being below the 10th percentile.

Question 12

What percentage of worm bolus obstruction cases show worms on abdominal x-rays?

Answer 12

More than 75%.

Question 13

What is the typical appearance of worms on an abdominal x-ray in cases of worm bolus obstruction?

Answer 13

A typical pattern of “coiled” worms.

Question 14

What are the potential complications of worm bolus intestinal obstruction?

Answer 14

Volvulus and perforation.

Question 15

How are uncomplicated worm bolus obstructions managed?

Answer 15

Conservatively, using the “drip and suck” method, with symptoms usually decreasing within 24-48 hours.

Question 16

What does the “drip and suck” method involve?

Answer 16

Insertion of a nasogastric (NG) tube, intravenous fluids for rehydration, and correction of the electrolyte profile.

Question 17

When is surgical management required for worm bolus obstruction?

Answer 17

If conservative management fails or if complications such as volvulus or perforation develop.

Question 18

What preparations are needed for surgery in worm bolus obstruction?

Answer 18

Continue “drip and suck” and administer broad-spectrum antibiotics.

Question 19

What is done if necrotic bowel is found during surgery for worm bolus obstruction?

Answer 19

The necrotic bowel is resected.

Question 20

What precaution should be taken when “milking out” obstructive worms during surgery?

Answer 20

Care must be taken to avoid releasing toxic substances that can damage the bowel.

Question 21

What is the helminthicide drug of choice for treating Ascaris lumbricoides?

Answer 21

Albendazole

Question 22

When should albendazole be administered in cases of uncomplicated worm bolus obstruction?

Answer 22

Only after obstructive symptoms have resolved.

Question 23

When should albendazole be administered in cases requiring surgery?

Answer 23

After the resolution of post-operative ileus to prevent clumping of dead worms within the bolus.

Question 24

What are gastrointestinal tract duplication cysts?

Answer 24

Rare congenital malformations that are duplicated sections of the GI tract with a smooth muscle coat and mucous membrane lining.

Question 25

Where can duplication cysts occur within the gastrointestinal tract?

Answer 25

Anywhere from the base of the tongue to the anus.

Question 26

How are duplication cysts named?

Answer 26

According to the organs with which they are associated.

Question 27

How are foregut duplication cysts categorized?

Answer 27

Based on embryonic origin into oesophageal, bronchogenic, and neuroenteric cysts.

Question 28

When is the abnormal budding of the embryonic foregut thought to occur, leading to duplication cysts?

Answer 28

At 5-8 weeks of gestation.

Question 29

What are the most common locations for gastrointestinal tract duplication cysts?

Answer 29

Ileum, oesophagus, and colon.

Question 30

What are the two types of duplication cysts, and how common are they?

Answer 30

Cystic (80%) and tubular (20%)

Question 31

How can duplication cysts relate to the bowel lumen?

Answer 31

They may communicate with the lumen or be totally separate from it.

Question 32

Can duplication cysts be intrinsic or extrinsic to the gastrointestinal tract wall?

Answer 32

Yes, they may be contained within the wall or extrinsic to it.

Question 33

When are duplication cysts usually detected?

Answer 33

Prenatally on ultrasound or in the first years of life when they become symptomatic.

Question 34

What factors influence the clinical presentation of duplication cysts?

Answer 34

Size, location, type, mucosal pattern, and presence of complications.

Question 35

What symptoms may intestinal duplication cysts produce?

Answer 35

Nausea, vomiting, abdominal distention, palpable abdominal mass, and recurrent abdominal pain.

Question 36

What is a common cause of recurrent abdominal pain in duplication cysts?

Answer 36

High pressure inside the cyst due to mucus accumulation.

Question 37

What is the primary imaging modality used to diagnose duplication cysts?

Answer 37

Ultrasound.

Question 38

What is the characteristic ultrasound appearance of a duplication cyst?

Answer 38

A “tram track” appearance with an inner hyperechoic epithelial lining and an outer hypoechoic smooth muscle layer.

Question 39

What creates the “tram track” appearance on ultrasound in duplication cysts?

Answer 39

The inner hyperechoic mucosal lining and the outer hypoechoic smooth muscle layer.

Question 40

Which additional imaging modalities can be helpful for duplication cysts besides ultrasound?

Answer 40

Magnetic Resonance (MR) and Computed Tomography (CT).

Question 41

What is the treatment of choice for duplication cysts?

Answer 41

Surgical removal of the cyst.

Question 42

What factors guide the surgical approach to duplication cysts?

Answer 42

Site, size, common wall attachment, and presence of complications

Question 43

In some cases, what part of the duplication cyst may be removed instead of the entire cyst?

Answer 43

Only the mucosa.

Question 44

What are duplication cysts?

Answer 44

Rare congenital anomalies of the digestive tract with unknown aetiology.

Question 45

What is the most common site for duplication cysts?

Answer 45

Distal ileum.

Question 46

What is the preferred diagnostic modality for duplication cysts?

Answer 46

Ultrasound (usually antenatal).

Question 47

Why is surgery necessary for duplication cysts?

Answer 47

To avoid complications.

Question 48

Why can duplication cysts present in many different ways?

Answer 48

Due to variations in size, location, type, mucosal pattern, and associated complications.

Question 49

What are postoperative intra-abdominal adhesions?

Answer 49

Fibrous bands that form between abdominal tissues and organs after surgery.

Question 50

Are postoperative adhesions common after abdominal surgery?

Answer 50

Yes, they are almost inevitable, but the extent and severity can vary.

Question 51

How common is adhesive bowel obstruction in the pediatric population?

Answer 51

It is considered relatively rare.

Question 52

What is the typical management technique for adhesive bowel obstruction in adults?

Answer 52

The “drip and suck” technique.

Question 53

Why is the “drip and suck” technique less effective in pediatric patients with adhesive bowel obstruction?

Answer 53

The outcomes are variable, and surgical adhesiolysis is often required.

Question 54

What is a common consequence of surgical adhesiolysis for adhesive bowel obstruction?

Answer 54

A high rate of adhesion reformation.

Question 55

What is a key part of the history when diagnosing adhesive bowel obstruction in children?

Answer 55

A history of an abdominal procedure, usually within the past 5 years.

Question 56

What are the typical symptoms of adhesive bowel obstruction?

Answer 56

Cramping abdominal pain, vomiting (initially feeds, then bile-stained, later feculent), increasing abdominal distension, and decreasing flatus and stool per rectum.

Question 57

What type of bowel sounds are associated with adhesive bowel obstruction?

Answer 57

Tinkling bowel sounds.

Question 58

How do tinkling bowel sounds and typical history help in diagnosis?

Answer 58

They help distinguish adhesive bowel obstruction from ileus due to other causes.

Question 59

What does an abdominal X-ray (AXR) show in cases of adhesive bowel obstruction?

Answer 59

Multiple dilated loops of bowel appearing as “tubes” rather than “cubes” of air, with possible air-fluid levels on an erect film.

Question 60

What is the initial management for a patient with adhesive bowel obstruction?

Answer 60

Resuscitation if in shock, correction of electrolyte abnormalities, and full rehydration.

Question 61

What is the purpose of placing a nasogastric tube (NGT) in adhesive bowel obstruction management?

Answer 61

To decompress the stomach and prevent further distension.

Question 62

What does “NPO” stand for in the management of adhesive bowel obstruction?

Answer 62

Nil Per Os (nothing by mouth).

Question 63

When is surgery indicated in adhesive bowel obstruction?

Answer 63

If the obstruction does not resolve after correcting physiological disturbances.

Question 64

What are the surgical steps in managing adhesive bowel obstruction?

Answer 64

Operative adhesiolysis, resection of necrotic bowel (if present), and re-establishment of bowel continuity.

Question 65

What does post-operative care involve after surgery for adhesive bowel obstruction?

Answer 65

Supportive care until bowel function returns

Question 66

Other causes discussed elsewhere in these notes:

Answer 66

• Bowel atresia and stenosis • Anorectal malformation • Meconium ileus, Meconium plug syndrome • Hirschsprung’s disease • NEC • Hypertrophic pyloric stenosis • Intussusception • Volvulus • Incarcerated hernias • Malignancies

Question 67

What congenital abnormalities can cause bowel obstruction?

Answer 67

Bowel atresia and stenosis, anorectal malformation, meconium ileus, and Hirschsprung’s disease.

Question 68

What are some functional or motility-related causes of bowel obstruction?

Answer 68

Meconium plug syndrome and Hirschsprung’s disease.

Question 69

What are some acquired causes of bowel obstruction in neonates and infants?

Answer 69

Necrotizing enterocolitis (NEC), intussusception, volvulus, and incarcerated hernias.

Question 70

What gastrointestinal condition characterized by thickened pyloric muscle can cause obstruction?

Answer 70

Hypertrophic pyloric stenosis.

Question 71

What is a rare but possible cause of bowel obstruction related to abnormal cell growth?

Answer 71

Malignancies