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Congenital obstruction of the gastrointestinal tract can occur in different parts of the small intestine or in several places simultaneously. This defect is suspected when the child begins to vomit a few hours after birth, and the belly slowly becomes more and more bloated. There are paroxysmal pains (the child flexes and groans), and after the meconium has gone, the child does not pass stools, even after laxative infusions.
What is congenital gastrointestinal obstruction?
Congenital gastrointestinal obstruction is a developmental defect characterized by an external or internal deviation from normal development. It can therefore occur in different sections of the small intestine or in several places at the same time. Abnormalities are found right after the baby is born, when the baby begins to vomit and his tummy becomes more and more bloated. Another characteristic symptom is dyspnoea and cyanosis. The child suffocates because the bronchial tree is flooded with contents in the mouth and stomach. Sometimes this content also flows out in the form of, for example, a foamy discharge mixed with the exhaled air. Then, a special catheter is immediately inserted through the nose into the stomach, which helps to exclude esophageal obstruction. Obstruction of the esophagus is evidenced by the wrapping of the catheter, visible on the monitor screen during the examination.
Causes of congenital obstruction of the gastrointestinal tract
Congenital defects of the gastrointestinal esophagus are divided into large defects, i.e. those that have serious consequences for the body, and small defects, which are only a cosmetic defect. Possible causes of congenital gastrointestinal obstruction include:
- genetic predisposition (gene mutations, chromosomal aberrations),
- environmental factors (biological, chemical) that damage the fetus between the 4th and 8th week of pregnancy.
Congenital malformations of the gastrointestinal tract – types
1. Meckel’s diverticulum – is a defect occurring in about 2 percent population; A diverticulum is a remnant of the yolk-intestinal tract located in the ileum. This condition is manifested by abdominal pain, passing stools mixed with blood, and sometimes by perforation of the intestines.
2. Hypertrophic stenosis of the pylorus – is a defect resulting from the deformation of the smooth muscles of the pylorus; the first symptoms of the disease appear in the second week of life of the newborn. This is a slight vomiting that may get worse over the next few weeks. In addition, the child may experience symptoms of dehydration, a bloated tummy and low weight gain.
3. Esophageal artesia – is a defect characterized by a break in the continuity of the esophagus. In some cases, it appears as a single defect, and in others, there are also defects in the heart, kidneys, rectum and limbs. It manifests itself as breathlessness, cyanosis, and excessive salivation and coughing. The symptom in prenatal examination is polyhydramnios.
4. Duodenal artesis – is a disease consisting in a complete or partial narrowing of the duodenal lumen, often associated with other developmental defects (e.g. Down’s syndrome). As with esophageal arthrosis, prenatal examination shows polyhydramnios. However, after the baby is born, vomiting with an admixture of bile and abdominal distension appear.
5. Umbilical hernia – is a congenital malformation characterized by the bulging of parts of the intestines due to a defect in the abdominal wall (navel area). Then the intestines are only covered with a thin layer of the peritoneum and amniotic fluid.
6. Congenital anus and rectal defects – sometimes they do not pose a threat and do not affect the functioning of the digestive tract; however, in some cases they are complex abnormalities related to defects in the spine or the genitourinary system.
7. Hirschsprung’s disease – it is characterized by a lack of mediating neurons in part of the large intestine and ganglion cells within the intramuscular and submucosal ganglia. This is manifested by a disturbance or complete absence of intestinal peristalsis and cramps in the aganglionic segment. This defect causes gastrointestinal obstruction in newborns, manifested by abdominal distension, constipation and vomiting. In extreme cases, it can lead to intestinal inflammation, a complication that can even lead to death.
Diagnosis and treatment of congenital gastrointestinal obstruction
Children suspected of having an obstruction, e.g., esophagus, should be immediately hospitalized. During transport, the child should be given oxygen continuously. A diagnosed congenital obstruction requires immediate surgical treatment. Imaging tests (X-ray of the abdominal cavity while standing) and a medical interview (with the child’s parents) are helpful in the diagnosis. In most cases, a diagnosis can be made based on the results of these two tests. In addition, laboratory blood tests and sometimes computed tomography, which shows the condition of the organs inside the abdominal cavity, are helpful. However, it should be remembered that CT is associated with the irradiation of the child’s body.
Treatment of any defect of congenital gastrointestinal obstruction should be initiated immediately after diagnosis. Before the procedure is performed, the child should receive parenteral nutrition. Only a quick procedure will give the child a chance to heal the child completely. The most important thing is that the child is under the care of experienced doctors.
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