Enterocolitis | Intestinal obstruction

Enterocolitis

An intestinal obstruction in a small child usually has different causes than in an adult. By far the most common cause of intestinal obstruction in young children is the so-called “invagination“. The term “intussusception” describes the invagination of a section of the intestine into a higher part of the intestinal tube within the gastrointestinal tract.

The cause of the intestinal obstruction through intussusception is unknown in most cases. As a consequence of the intestinal obstruction, the affected infant is restricted in the passage of the food. An intestinal obstruction caused by an intussusception mainly affects infants before the age of three.

The majority of cases are even observed in children who are not older than one year. In principle, the symptoms of intestinal obstruction in small children are no different from those of adults. The typical symptoms of intestinal obstruction in infants include severe, wave-like abdominal pain and vomiting.

The affected infant usually tends to keep his or her legs in a dressed and relaxed position. At the beginning of the disease, the infant suffers from severe diarrhoea, which, however, is replaced by severe constipation as the disease progresses. The infants affected by intestinal obstruction through intussusception look conspicuously ill in most cases.

The clear discoloration of the skin colour (pale, grey) and the strong perspiration are particularly striking. In the case of an intestinal obstruction caused by an intussusception, bloody or slimy stools are released very late. An affected infant typically cries or cries because of the severe pain.

Most children cannot be calmed down in the presence of such an intestinal obstruction. If the presence of an intestinal obstruction is suspected, the infant should be presented to a paediatrician (paediatrician) immediately. In order to check the suspicion, the paediatrician will examine the infant’s abdomen extensively.

An intestinal obstruction due to intussusception can be palpated from the outside in most cases. In addition, an ultrasound examination (sonography) can help to confirm the diagnosis “intestinal obstruction due to intussusception”. If the ultrasound findings are unclear, imaging can also be performed by taking an x-ray of the abdomen.

In the early stages, the intestinal obstruction in the infant can often be resolved by an enema and/or targeted massage of the abdomen. If this is not successful within a short period of time or if the intestinal obstruction recurs despite successful treatment, surgical therapy must be initiated. During a surgical procedure under general anaesthesia, the attending physician exposes the invaginated intestine and moves the individual sections into their original position.

Intestinal obstruction in infants

Even in an infant the intestinal obstruction is in most cases caused by an intussusception. The typical symptoms as well as the treatment are similar to those of an infant. Another common cause of intestinal obstruction in an infant is the so-called “meconium ileus” (ileus is the technical term for intestinal obstruction).

The term “meconium” refers to the counting, sticky fetal stool. In this disease of the infant, the intestinal obstruction is caused directly by this sticky stool. In most cases (over 90 percent of known cases), intestinal obstruction is associated with cystic fibrosis (synonym: cystic fibrosis).

In the context of this hereditary clinical picture, a loss of function of a certain chloride channel (CFTR) occurs. As a result of this loss of function, highly viscous, tough mucus is formed in the area of the gastrointestinal tract. The secretion of the enzymes of the pancreas is also restricted in the context of cystic fibrosis.

The affected infants secrete viscous secretions and insufficiently split the food components. The consequence is often the sticking of the intestinal lumen and the development of intestinal obstruction. An infant suspected of having an intestinal obstruction should be examined immediately by a paediatrician.

In the course of a clinical examination, signs of cystic fibrosis can usually be quickly observed. Especially the so-called “chloride sweat test” plays a decisive role in the diagnosis of intestinal obstruction in the infant. Imaging procedures in the form of radiographic images of the abdomen (abdominal voiding image) usually show granular intestinal loops that are distended like bubbles.

This phenomenon is known in medical terminology as the “Neuhauser sign”. If the result is positive and confirms the presence of an intestinal obstruction in the infant, suitable therapy should be initiated immediately. As a rule, the treating specialist starts with a gastrografin enema performed under fluoroscopy.

In this way the meconium can be transported under certain circumstances. In most infants, this method must be repeated several times in order to completely restore intestinal passage. If complications occur during this first attempt at therapy, the affected infant must be treated surgically as soon as possible.

The prognosis of this form of intestinal obstruction in infants is very good if the diagnosis is made promptly and the therapy is initiated quickly. However, if the intestinal obstruction is based on cystic fibrosis, there is no chance of recovery despite good treatment options. Although the intestinal obstruction can be repaired, the underlying disease cannot be cured.