Content area
Full Text
Pediatr Radiol (2013) 43:318329 DOI 10.1007/s00247-012-2573-1
REVIEW
A pattern-based approach to bowel obstruction in the newborn
Charles M. Maxfield & Brett H. Bartz & Jennifer L. Shaffer
Received: 22 June 2012 /Revised: 21 October 2012 /Accepted: 29 October 2012 /Published online: 12 December 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract Intestinal obstruction is common in newborns, and the radiologist plays a critical role in the care of these children. Diagnosing and managing the potentially obstructed newborn can be challenging, especially given the myriad underlying pathologies that range from benign to acutely life-threatening. A familiarity with the most common diagnoses is essential, but equally important to the radiologist is a systematic approach to management of the child in this setting. We propose an approach based on the recognition of eight radiographic patterns, five upper gastrointestinal examination (UGI) patterns and four contrast enema patterns. Recognition of these patterns directs further imaging when necessary and allows triage of children who can be managed medically, those requiring elective or urgent surgery and those requiring emergent surgery.
Keywords Newborn . Neonatal . Obstruction .
Gastrointestinal
Introduction
The radiologist plays a crucial role in the diagnosis and management of the vomiting newborn. This common and potentially life-threatening presentation is not limited to childrens hospitals. All radiologists must be familiar with the workup and management of potential bowel obstruction in the newborn. Etiologies of vomiting in the newborn
include surgical and non-surgical causes ranging from the benign and nearly universal gastroesophageal reflux (GER) to life-threatening midgut volvulus [1]. In between the benign and the life-threatening are myriad etiologies of vomiting that produce different patterns on abdominal radiographs, contrasted upper gastrointestinal examination (UGI), and contrast enema. A familiarity with these patterns allows triage of cases that can be managed medically, those requiring elective surgery and those requiring emergent surgery.
We present a pattern-based approach to the workup and management of the vomiting newborn. Through identification of eight patterns on abdominal radiograph, five patterns on UGI and four patterns on contrast enema, the radiologist can competently and confidently manage this common and potentially life-threatening clinical presentation.
Clinical presentation
Vomiting newborns sometimes present with additional signs and symptoms, such as feeding intolerance, abdominal distension, failure to pass meconium and peritoneal signs [2]. The symptoms do...