Intestinal obstruction in the baby
Definition of intestinal obstruction in babies
The intestinal obstruction is a pathological interruption of the intestinal passage. The term ileus can also be found in technical language. This is an acutely life-threatening situation that requires immediate medical treatment. This topic now specifically deals with intestinal obstruction in young children and newborns.
How can you recognize an intestinal obstruction in a baby?
When a baby has an intestinal obstruction, they are usually very tearful and cry a lot. If a baby eats less than normal for a long time or has less appetite, this can also be due to problems in the gastrointestinal tract.
In the case of severe pain, the baby can increasingly lie in a gentle posture in which, for example, it draws its legs to the body. It can also be observed that there are pain-free moments that are followed by painful ones. Because the intestinal obstruction means that food can no longer be transported in the gastrointestinal tract, babies usually vomit or have constipation and stool retention.
Read more about these topics:
- Vomiting in the baby
- Diarrhea in the baby
- Constipation in the baby
Signs and symptoms
First of all, the baby feels increasingly sick, vomits, and has gas and diarrhea. Bloody or slimy stool as well as subsequent constipation and stool retention can also indicate an intestinal obstruction. At the beginning of the disease, the vomit is stomach contents and bile. If the disease is advanced, the newborn will also vomit stool. In addition, a hardened abdominal wall or a bloated, tender stomach can be an indication of a blockage in the area of the intestinal tract.
An advanced intestinal obstruction causes massive pain. The affected newborns are very tearful, anxious, scream a lot and squirm with pain. One observes that they draw their legs strongly and are sometimes very apathetic. Typical for an intestinal obstruction can be a short-term freedom from symptoms, in which the pain subsides and the baby seeks proximity to the mother or father and a subsequent period of extremely painful cramps.
The high level of stress can lead to a state of shock. When shocked by intestinal obstruction, the baby is cold sweaty, pale and weak. There is severe pain when pressure is applied to the affected area. In addition, there may be blood in the stool, which indicates damage to the intestinal wall. The longer the stool remains in the intestine, the harder it becomes (because the villi naturally remove water from the feces) and the more it damages the intestinal wall when it passes through.
The pain usually increases over time. In addition to the symptoms mentioned, there may also be a fever.
Read more on the subject at: These are the signs of a bowel obstruction
A bowel obstruction can lead to increased flatulence. This manifests itself in the baby as increased puffing. Since the gastrointestinal passage comes to a standstill in the event of an intestinal obstruction, the food pulp in the intestine is no longer transported. As a result, the food pulp in the intestine is digested by the bacteria there and gases are generated. These gases make themselves felt as flatulence or even as farts in the baby.
Is a bowel obstruction in babies dangerous?
A bowel obstruction can cause a variety of complications if detected later. First, the stool backs up into the upper gastrointestinal tract. This can lead to serious infections as the intestinal bacteria get to places where they can harm. Furthermore, an intestinal rupture can occur, in which the contents of the intestine enter the abdominal cavity and can trigger severe peritonitis. Blood poisoning caused by the intestinal bacteria floating in the blood vessels also worsens the prognosis. In addition, an intestinal obstruction often leads to a lack of fluids, as not enough water is withdrawn from the food pulp. This can have consequences for the baby's circulation.
Is an intestinal obstruction possible despite a bowel movement?
With a mechanical intestinal obstruction, i.e. a blockage of the intestinal tube, bowel movements can occur, especially at the beginning, because the intestine is not yet completely emptied. In the initial phase of an intestinal obstruction, the part of the intestine that lies behind the closed area can still empty. Depending on the cause of the intestinal obstruction, bowel movements, usually diarrhea, can also occur later, especially if there is no complete intestinal obstruction and a little intestinal content still passes the narrowed intestinal passage. The intestine reacts to the blockage with a stronger movement and pushes small, mostly thin amounts of stool past the constriction. The diarrhea occurs because the increased movement means that the water absorption from the stool does not work properly and the stool becomes mushy.
Is an intestinal obstruction possible after an operation?
After an operation, scarring can develop in the abdomen. Loops of the intestine can become trapped in these adhesions and this can lead to an intestinal obstruction. After surgery, attention should be paid to the symptoms mentioned above in order to detect a possible interruption of the gastrointestinal passage at an early stage.
Is an intestinal obstruction possible after vaccination?
A bowel obstruction in the baby can be a rare side effect of using the rotavirus vaccine. Studies have shown that vaccination of infants against rotaviruses with the Rotarix® or RotaTeq® vaccine has a slightly increased risk of intestinal invagination. One to five children in 100,000 vaccinated may develop a bowel obstruction. Nevertheless, experts recommend vaccination against rotaviruses, as the virus is highly contagious and infection with these viruses can lead to severe inflammation in the gastrointestinal tract.
Read more on this topic: Rotavirus vaccination and should I have my baby vaccinated?
It makes sense and is recommended by the STIKO (Standing Vaccination Commission) to have the vaccination in good time, i.e. before the 24th or 32nd week of life. The risk of bowel invasions increases with the age of the infant. After a rotavirus vaccination, attention should be paid to the symptoms mentioned above. If symptoms of intestinal obstruction are observed in the baby after a vaccination, it is advisable to consult a doctor as soon as possible for clarification.
Causes of intestinal obstruction in babies
There are many different causes that can cause a bowel obstruction. Often the cause cannot be clearly determined. What all have in common, however, is that the passage of the intestinal contents to the rectum and ultimately the excretion are impeded or interrupted. Usually the intestinal contents move in undulating movements, which are known as peristalsis referred to, in the intestine to the rectum, where it remains until excretion.
If the passage is now interrupted at one point, the intestinal contents continue to build up and massive pain can occur. Anything that could block the intestines can be considered as causes. For example
- swallowed foreign bodies (possibly small toys)
- Gallstones or also
- entangled intestinal loops
lead to an intestinal obstruction. In addition, scarring can develop after an operation, which obstructs the intestinal peristalsis and passage. Congenital malformations of the intestine are also conceivable, so that it cannot fulfill its function properly.
An example of a congenital malformation is atresia of the intestine. An atresia is the occlusion or the absence of hollow organs such as the intestine. Also innate Stenoses, Constrictions, are causes of an intestinal obstruction.
Also important is the so-called volvulus, a twisting of the intestine in which a loop of intestine winds around itself and thus interrupts the passage of feces.
The most important and most common cause, however, is a completely different one, namely intussusception (invagination) of the small intestine. The small intestine turns inside out in such a way that its position and peristalsis stress the appendix and the ascending large intestine.
Another important cause is a meconium ileus. Meconium is the baby's first shedding.
This is not a stool, but a mass of thickened bile, amniotic fluid, and swallowed hair and skin cells that naturally accumulate in the intestines during pregnancy. This mass is excreted after birth and is replaced by stool when ingested. If the meconium is not excreted, this indicates an intestinal obstruction in the baby.
Bowel obstruction in newborns is a symptom that is also associated with cystic fibrosis and Hirschsprung's disease.
So you can see that the causes are very broad, but the result is roughly the same: a pathological change in the intestinal passage.
Types of intestinal obstruction in the baby
There are two types of intestinal obstruction:
- more functional and
- mechanical intestinal obstruction
Mechanical intestinal obstruction is the form of intestinal obstruction in which the passage of the intestine is obstructed by obstacles. These can be tumors, gallstones, foreign bodies or chronic diseases such as Crohn's disease.
The functional ileus is an intestinal obstruction caused by a disturbed peristalsis. There is cramping or paralysis of the intestinal muscles (so-called paralytic ileus) who have peritonitis (Peritonitis) can go hand in hand. However, this is rarely the case with newborns and is therefore not a typical type of intestinal obstruction in babies.
Diagnosing intestinal obstruction in the baby
So how is it determined that the baby is suffering from an intestinal obstruction? First of all, if you have noticeable symptoms, as described above, a Consulted a doctor become. This feel the baby's stomach for pain and induration down.
After that, a Ultrasound examination carried out. These are often characteristic Pendulum movements of the intestinal contents to see. The stool oscillates back and forth in the intestine. In addition, you can see inflated intestinal sections filled with air or liquid. A so-called "starvation bowel" is also often seen, i.e. are behind the breech empty intestinal sections often collapsed (collapsed) because they're empty.
In addition, a X-ray image prompted to take a closer look at the intestines. The doctor can also eavesdrop on the stomach and listen to the intestinal noises. At a mechanical ileus does he hear a so-called "Hyperperistalsis“, So an increased bowel movement. With a functional ileus with failure of the intestinal peristalsis prevails however, dead silence. If necessary, a contrast agent can also be given to reduce the To narrow down the location of the closure more precisely. At last you do the CT scan to use for diagnostics.
Therapy for intestinal obstruction in the baby
The therapy for intestinal obstruction in babies depends on its cause. In the case of intussusception of the intestine, one tries to move the intestine back into the correct position by means of an enema with saline solution or a contrast enema. An intestinal obstruction in babies caused by meconium is also treated with the intention of flushing out the meconium congestion. However, surgery is often needed if these measures do not help.
For more information, see: OP of an intestinal obstruction
In severe cases, when the intestine is already severely damaged, the affected piece must be surgically removed. Fortunately, this is rarely necessary. During the operation, the abdominal wall is opened, thus allowing access to the intestine. The surgeon can then surgically move the bowel back into position. Operations are usually unavoidable in the case of congenital malformations, for example.
After the operation, the children remain in the intensive care unit and are observed. At first you are not allowed to eat independently and are fed parenterally. This means that they are fed through an infusion to relieve the intestines. There is also the option of feeding through a gastric tube. This ensures that the bowel is relieved of pressure for a long enough time to heal well. In the case of inflammation or infectious disease of the intestine, additional medication is given.
The prognosis for intestinal obstruction in babies depends on the cause and when it is diagnosed.
In the case of newborns, the pediatric nurses pay attention to the babies' bowel movements and can react immediately to any abnormalities. In this case the prognosis is very good. In general, a mechanical blockage can be treated surgically.
Therapy is more difficult if the intestinal muscles are paralyzed, as occurs, for example, in Hirschsprung's disease. If detected early, an operation can also be carried out, but this usually means removing the affected section of the intestine, as the nerves are not developed there. If detected later, an intestinal obstruction can lead to complications such as an intestinal rupture (leakage of intestinal contents into the abdominal cavity). This leads to a considerably worse prognosis.