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Surgical Management of Meatal Stenosis with Meatoplasty
Published on: November 30, 2010
Intestinal obstruction in neonatal/pediatric surgery
1Royal Hospital for Sick Children and University Department of Surgical Paediatrics, University of Glasgow, Scotland, UK.
Insights
Early diagnosis and prompt surgical intervention are crucial for managing intestinal obstruction in infants and children. Timely treatment significantly reduces the risks of severe complications and mortality associated with this condition.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Gastroenterology
Background:
- Intestinal obstruction presents diverse causes in neonates and children, ranging from congenital anomalies to acquired conditions.
- Delayed diagnosis in neonates leads to rapid deterioration, increased morbidity, and mortality, complicating surgical outcomes.
Purpose of the Study:
- To review the various causes, diagnostic approaches, and management strategies for intestinal obstruction in pediatric patients.
- To emphasize the importance of early detection and appropriate surgical intervention in improving patient outcomes.
Main Methods:
- Comprehensive review of literature on pediatric intestinal obstruction.
- Discussion of clinical presentations, diagnostic tools (radiography), and surgical management principles.
- Analysis of factors influencing morbidity and mortality, including congenital anomalies and treatment delays.
Main Results:
- Intestinal obstruction necessitates prompt clinical recognition and accurate interpretation of diagnostic findings for timely treatment.
- Surgical management is the mainstay, with exceptions noted; appropriate resuscitation is vital pre-operatively.
- Modern pediatric and neonatal intensive care have drastically lowered mortality rates, though associated anomalies and diagnostic delays remain critical factors.
Conclusions:
- Early diagnosis and prompt surgical intervention are paramount for successful management of intestinal obstruction in neonates and children.
- Multidisciplinary care and advances in intensive care have improved outcomes, but vigilance for congenital anomalies and timely treatment are essential.
- Ongoing developments in pediatric surgery and critical care hold promise for further reducing mortality in complex cases.
Abstract:
Intestinal obstruction in the newborn infant and older child may be due to a variety of conditions, including atresia and stenosis, annular pancreas, malrotation, duplication cyst, meconium ileus, meconium plug syndrome and neonatal small left colon syndrome, Hirschsprung's disease, neoplasia, trauma, and other rarer causes. The mode of presentation can be acute or more chronic with systemic upset due to shock. Neonates, more so than older children, with unrecognized intestinal obstruction deteriorate rapidly, show an increase of associated morbidity and mortality and appropriate surgical treatment becomes more hazardous. Early diagnosis depends largely on the prompt detection of obstructive manifestations by the clinician and the subsequent accurate interpretation of radiographic findings and other investigations, leading to definitive treatment, which should always be preceded by appropriate resuscitation/preparation of the infant/child. Management of intestinal obstruction will almost always be surgical, apart from some notable exceptions and all are discussed in more detail. With the advent of pediatric and neonatal intensive care and multidisciplinary care, the morbidity and mortality of cases of intestinal obstruction reported in current series is generally extremely low and mainly determined by the coexistence of other major congenital anomalies (eg, cardiac), delays in diagnosis and treatment or coexisting medical conditions. Newer treatments and future developments may reduce the residual mortality in such cases as ultrashort-bowel syndrome.
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