Intestinal obstruction and perforation are serious conditions in children that require immediate medical attention.

• Intestinal Obstruction occurs when the intestine is blocked, preventing the passage of food, fluids, and gas.
• Intestinal Perforation happens when there is a hole or tear in the intestinal wall, leading to leakage of intestinal contents into the abdomen, causing infection and peritonitis.

Both conditions can be life-threatening and often require emergency surgery.

1. Causes of Intestinal Obstruction in Children

Obstruction can be congenital (present at birth) or acquired (develops later in life).

A. Congenital Causes

1. Intestinal Atresia & Stenosis
   • The intestine is either completely blocked (atresia) or narrowed (stenosis) from birth.
   • Common in the small intestine (duodenal, jejunal, or ileal atresia).
2. Malrotation with Volvulus
   • Abnormal twisting of the intestines, cutting off blood supply.
   • Life-threatening if untreated.
3. Hirschsprung’s Disease
   • Absence of nerve cells in the intestine leads to severe constipation and blockage.
4. Meconium Ileus (In Cystic Fibrosis Babies)
   • Thick, sticky meconium (first stool) blocks the intestines.

B. Acquired Causes

1. Intussusception
   • A part of the intestine telescopes into another, causing a blockage.
   • Common in infants 3–12 months old.
2. Adhesions (Scar Tissue)
   • After previous surgery, scar tissue forms and blocks the intestine.
3. Infections & Inflammation (e.g., Appendicitis, Crohn’s Disease)
   • Swelling can block the intestine.
4. Hernias & Tumors
   • These can physically obstruct the intestines.

2. Causes of Intestinal Perforation

Perforation occurs when there is a tear in the intestine, leading to leakage of its contents into the abdominal cavity. This causes peritonitis (severe infection and inflammation of the abdomen).

Common Causes:

✅ Necrotizing Enterocolitis (NEC) – In Premature Babies
✅ Trauma or Injury to the Abdomen
✅ Severe Appendicitis (Burst Appendix)
✅ Bowel Obstruction Leading to Ischemia (Loss of Blood Supply)
✅ Swallowed Foreign Bodies (Sharp Objects, Batteries, Magnets)

3. Symptoms of Intestinal Obstruction & Perforation

A. Symptoms of Intestinal Obstruction

✔ Severe abdominal pain (colicky pain)
✔ Vomiting (often green bile-stained)
✔ Abdominal distension (swelling)
✔ Inability to pass stool or gas
✔ Irritability & crying (in infants)

B. Symptoms of Intestinal Perforation

⚠ Sudden, severe abdominal pain
⚠ Rigid, swollen abdomen
⚠ Fever & rapid heart rate
⚠ Severe vomiting & nausea
⚠ Signs of shock (low blood pressure, pale skin, confusion)

🔴 Perforation is a surgical emergency. If untreated, it leads to sepsis and multi-organ failure. 🔴

4. Diagnosis of Intestinal Obstruction & Perforation

Doctors use various tests to confirm the condition:

🔎 X-ray (Abdominal X-ray): Shows gas patterns indicating obstruction or air leaks in perforation.
🔎 Ultrasound (For Intussusception): Detects telescoped intestine.
🔎 Contrast Study (Barium Enema): Used in non-emergency cases.
🔎 CT Scan: Provides detailed imaging of obstruction or perforation.
🔎 Blood Tests: Check for infection, dehydration, or electrolyte imbalances.

5. Treatment of Intestinal Obstruction & Perforation

A. Initial Stabilization

🚑 Hospital Admission & Monitoring
🚑 NPO (No Oral Feeding) – To rest the intestines.
🚑 IV Fluids & Electrolyte Replacement – To prevent dehydration.
🚑 Nasogastric Tube (NG Tube) – Removes excess gas and fluids from the stomach.
🚑 Antibiotics – If infection is suspected.

B. Treatment of Intestinal Obstruction

1. Non-Surgical Methods (For Some Cases)

✅ Air/Barium Enema (For Intussusception) – Helps unfold the intestine.
✅ Medications & Laxatives (For Hirschsprung’s Disease & Constipation-Related Blockage).

2. Surgery for Severe Cases

🔹 Laparoscopic or Open Surgery: Removes blockage and reconnects the intestine.
🔹 Resection & Anastomosis: If a part of the intestine is dead, it is removed and rejoined.
🔹 Colostomy/Ileostomy: In severe cases, a temporary stoma (opening in the abdomen) may be needed.

C. Surgery for Intestinal Perforation

⚠ Emergency Laparotomy (Open Surgery)

• The hole in the intestine is repaired.
• If there is severe infection, a temporary stoma (colostomy/ileostomy) may be created.
• The abdominal cavity is washed thoroughly to prevent infection.

6. Recovery & Post-Surgical Care

🏥 Hospital Stay (5-14 Days, Depending on Severity)
🥣 Slow Introduction of Oral Feeds (Starting with clear liquids).
💊 Pain Management & Antibiotics to prevent infection.
🩺 Follow-Up X-rays/Scans to monitor healing.

7. Possible Complications

❌ Sepsis (Blood Infection) – If perforation is untreated
❌ Bowel Strictures (Narrowing of Intestine After Surgery)
❌ Short Bowel Syndrome – If a large section of the intestine is removed
❌ Adhesions (Scar Tissue Causing Future Obstructions)

8. Preventing Intestinal Problems in Children

✅ Proper prenatal care – Detect congenital conditions early.
✅ Early treatment of infections – Prevents complications like perforation.
✅ Avoid giving children small objects (to prevent swallowed foreign bodies).
✅ Timely medical check-ups – For conditions like Hirschsprung’s disease and malrotation.