Pediatric Small-Bowel Obstruction Differential Diagnoses

  • Author: Jaime Shalkow, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Feb 16, 2012
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of pediatric small-bowel obstruction include the following:

  • Abdominal trauma
  • Intestinal volvulus
  • Intussusception
  • Irritable bowel syndrome
  • Meckel diverticulum
  • Mesenteric and omental cysts
  • Necrotizing enterocolitis
  • Omphalocele and gastroschisis
  • Pediatric hernias
  • Hypertrophic pyloric stenosis
  • Small intestinal atresia and stenosis
  • Inflammatory bowel disease
  • Intestinal pseudo-obstruction

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Jaime Shalkow, MD  Head of Surgical Oncology, Division of Surgery, National Institute of Pediatrics, Mexico; Head-Professor of Pediatric Surgical Oncology, Universidad Nacional Autonoma de Mexico

Jaime Shalkow, MD is a member of the following medical societies: American College of Surgeons, International Society of Pediatric Surgical Oncology, Mexican Association of Pediatric Surgery, Mexican Association of Pediatrics, Mexican Society of Oncology, and Pacific Association of Pediatric Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Jose Asz, MD  Professor of Embryology, Assistant Professor of Surgery and Pediatrics, Faculty of Medicine, Universidad Nacional Autonoma de Mexico; Consulting Staff, Department of General Surgery, National Institute of Pediatrics, Mexico

Disclosure: Nothing to disclose.

Adrian Florens, MD, FAAP  Attending Faculty Staff, Department of Pediatrics, Division of Neonatology, John H Stroger Hospital of Cook County

Adrian Florens, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Nicholas A Shorter, MD  Professor of Clinical Surgery and Clinical Pediatrics, State University of New York Downstate University; Division Chief, Department of Surgery, Division of Pediatric Surgery, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Additional Contributors

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Jorge H Vargas, MD Professor of Pediatrics and Clinical Professor of Pediatric Gastroenterology, David Geffen School of Medicine, University of California at Los Angeles; Consulting Physician, Department of Pediatrics, University of California at Los Angeles Health System

Jorge H Vargas, MD is a member of the following medical societies: American Liver Foundation, American Society for Gastrointestinal Endoscopy, American Society for Parenteral and Enteral Nutrition, Latin American Society of Pediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Wyllie Robert. Intestinal atresia,stenosis and malrotation. In: Nelson Textbook of Pediatrics. 18. Sounders; 327.

  2. Nylund CM, Denson LA, Noel JM. Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study. J Pediatr. May 2010;156(5):761-5. [Medline].

  3. Okimoto S, Hyodo S, Yamamoto M, Nakamura K, Kobayashi M. Association of viral isolates from stool samples with intussusception in children. Int J Infect Dis. Sep 2011;15(9):e641-5. [Medline].

  4. Ruscher KA, Fisher JN, Hughes CD, Neff S, Lerer TJ, Hight DW, et al. National trends in the surgical management of Meckel's diverticulum. J Pediatr Surg. May 2011;46(5):893-6. [Medline].

  5. Nikolic H, Palcevski G, Saina G, Peršic M. Chronic intussusception in children caused by Ascaris lumbricoides. Wien Klin Wochenschr. May 2011;123(9-10):294-6. [Medline].

  6. Vestergaard H, Westergaard T, Wohlfahrt J, et al. Association between intussusception and tonsil disease in childhood. Epidemiology. Jan 2008;19(1):71-4. [Medline].

  7. Wang SM, Huang FC, Wu CH, Ko SF, Lee SY, Hsiao CC. Ileocecal Burkitt's lymphoma presenting as ileocolic intussusception with appendiceal invagination and acute appendicitis. J Formos Med Assoc. Jun 2010;109(6):476-9. [Medline].

  8. van Lier MG, Mathus-Vliegen EM, Wagner A, van Leerdam ME, Kuipers EJ. High cumulative risk of intussusception in patients with Peutz-Jeghers syndrome: time to update surveillance guidelines?. Am J Gastroenterol. May 2011;106(5):940-5. [Medline].

  9. Laje P, Stanley CA, Adzick NS. Intussusception after pancreatic surgery in children: a case series. J Pediatr Surg. Jul 2010;45(7):1496-9. [Medline].

  10. Fraser JD, Aguayo P, Ho B, Sharp SW, Ostlie DJ, Holcomb GW 3rd. Laparoscopic management of intussusception in pediatric patients. J Laparoendosc Adv Surg Tech A. Aug 2009;19(4):563-5. [Medline].

  11. Rajput A, Gauderer MW, Hack M. Inguinal hernias in very low birth weight infants: incidence and timing of repair. J Pediatr Surg. Oct 1992;27(10):1322-4. [Medline].

  12. Ikossi DG, Shaheen R, Mallory B. Laparoscopic femoral hernia repair using umbilical ligament as plug. J Laparoendosc Adv Surg Tech A. Apr 2005;15(2):197-200. [Medline].

  13. Chan KL, Hui WC, Tam PK. Prospective randomized single-center, single-blind comparison of laparoscopic vs open repair of pediatric inguinal hernia. Surg Endosc. Jul 2005;19(7):927-32. [Medline].

  14. Boley SJ, Cahn D, Lauer T, Weinberg G, Kleinhaus S. The irreducible ovary: a true emergency. J Pediatr Surg. Sep 1991;26(9):1035-8. [Medline].

  15. Mboyo A, Goura E, Massicot R, et al. An exceptional cause of intestinal obstruction in a 2-year-old boy: strangulated hernia of the ileum through Winslow's foramen. J Pediatr Surg. Jan 2008;43(1):e1-3. [Medline].

  16. Gingalewski C, Lalikos J. An unusual cause of small bowel obstruction: herniation through a defect in the falciform ligament. J Pediatr Surg. Feb 2008;43(2):398-400. [Medline].

  17. El-Gohary Y, Alagtal M, Gillick J. Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatr Surg Int. Feb 2010;26(2):203-6. [Medline].

  18. Prasad A, Chadha R. Intestinal Obstruction. In: Gupta D, Ed. Pediatric Surgery: Diagnosis and Management. New Delhi, India: Jaypee Import; 2009.

  19. Tsao KJ, St Peter SD, Valusek PA, et al. Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg. Jun 2007;42(6):939-42; discussion 942. [Medline].

  20. Ohno Y, Kanematsu T. Annular pancreas causing localized recurrent pancreatitis in a child: report of a case. Surg Today. 2008;38(11):1052-5. [Medline].

  21. Kihne M, Ramanujam TM, Sithasanan N. Mesocolic hernia: a rare cause of intestinal obstruction in childhood. Med J Malaysia. Jun 2006;61(2):251-3. [Medline].

  22. Villalona GA, Diefenbach KA, Touloukian RJ. Congenital and acquired mesocolic hernias presenting with small bowel obstruction in childhood and adolescence. J Pediatr Surg. Feb 2010;45(2):438-42. [Medline].

  23. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. Jan 20 2011;364(3):255-64. [Medline].

  24. Morgan JA, Young L, McGuire W. Pathogenesis and prevention of necrotizing enterocolitis. Curr Opin Infect Dis. Jun 2011;24(3):183-9. [Medline].

  25. Henry MC, Moss RL. Neonatal Necrotizing Enterocolitis. Seminars in Pediatric Surgery. May 72008;17:98-109.

  26. Tayman C, Tonbul A, Kahveci H, et al. C5a, a complement activation product, is a useful marker in predicting the severity of necrotizing enterocolitis. Tohoku J Exp Med. 2011;224(2):143-50. [Medline].

  27. Young CM, Kingma SD, Neu J. Ischemia-reperfusion and neonatal intestinal injury. J Pediatr. Feb 2011;158(2 Suppl):e25-8. [Medline].

  28. Zhang Y, Ortega G, Camp M, Osen H, Chang DC, Abdullah F. Necrotizing enterocolitis requiring surgery: outcomes by intestinal location of disease in 4371 infants. J Pediatr Surg. Aug 2011;46(8):1475-81. [Medline].

  29. Stevenson DK, Kerner JA, Malachowski N. Late morbidity among survivors of necrotizing enterocolitis. Pediatrics. 1980;66:925-7.

  30. Sharma S, Gupta D. Gastric Volvulus. In: Gupta D, Ed. Pediatric Surgery: Diagnosis and Management. New Delhi, India: Jaypee Import; 2009.

  31. Herndon CD, Rink RC, Cain MP, et al. In situ Malone antegrade continence enema in 127 patients: a 6-year experience. J Urol. Oct 2004;172(4 Pt 2):1689-91. [Medline].

  32. Foley PT, Sithasanan N, McEwing R, et al. Enteric duplications presenting as antenatally detected abdominal cysts: is delayed resection appropriate?. J Pediatr Surg. Dec 2003;38(12):1810-3. [Medline].

  33. Ladd W, Gross RE. Surgical treatment of duplication of the alimentary tract: Enterogenous cysts, enteric cysts, or ileum duplex. Surg Gynecol Obstet. 1940;70:295-307.

  34. Karrer FM, Potter DD, Calkins CM. Pediatic Duodenal Atresia. Medscape Reference. Available at http://emedicine.medscape.com/article/932917-overview. Accessed January 9, 2012.

  35. Lewis N, Glick P. Pediatric Duodenal Atresia and Stenosis Surgery. Medscape Reference. Available at http://emedicine.medscape.com/article/935748-overview. Accessed January 9, 2012.

  36. Moss RL, Kalish LA, Duggan C, et al. Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study. J Perinatol. Oct 2008;28(10):665-74. [Medline].

  37. Berman L, Moss RL. Necrotizing enterocolitis: an update. Semin Fetal Neonatal Med. Jun 2011;16(3):145-50. [Medline].

  38. Duro D, Kalish LA, Johnston P, et al. Risk factors for intestinal failure in infants with necrotizing enterocolitis: a Glaser Pediatric Research Network study. J Pediatr. Aug 2010;157(2):203-208.e1. [Medline]. [Full Text].

  39. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. Jan 1978;187(1):1-7. [Medline].

  40. Rastogi S, Olmez I, Bhutada A, Rastogi D. Drop in platelet counts in extremely preterm neonates and its association with clinical outcomes. J Pediatr Hematol Oncol. Dec 2011;33(8):580-4. [Medline].

  41. Hooker RL, Hernanz-Schulman M, Yu C, et al. Radiographic evaluation of intussusception: utility of left-side-down decubitus view. Radiology. Sep 2008;248(3):987-94. [Medline].

  42. Roskind CG, Ruzal-Shapiro CB, Dowd EK, et al. Test characteristics of the 3-view abdominal radiograph series in the diagnosis of intussusception. Pediatr Emerg Care. Nov 2007;23(11):785-9. [Medline].

  43. Rosenbaum J, Alex G, Simpson D, Catto-Smith A. Luminal view of an intussusception captured by capsule endoscopy. J Pediatr Gastroenterol Nutr. Aug 2011;53(2):127. [Medline].

  44. Sizemore AW, Rabbani KZ, Ladd A, et al. Diagnostic performance of the upper gastrointestinal series in the evaluation of children with clinically suspected malrotation. Pediatr Radiol. May 2008;38(5):518-28. [Medline].

  45. Fazio VW, Cohen Z, Fleshman JW, et al. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum. Jan 2006;49(1):1-11. [Medline].

  46. Shah U, Shafiq Y, Khan MA. Gastrograffin use in distal intestinal obstruction syndrome of cystic fibrosis. J Ayub Med Coll Abbottabad. Jan-Mar 2007;19(1):58-60. [Medline].

  47. Yagci G, Kaymakcioglu N, Can MF, et al. Comparison of Urografin versus standard therapy in postoperative small bowel obstruction. J Invest Surg. Nov-Dec 2005;18(6):315-20. [Medline].

  48. Gul A, Tekoglu G, Aslan H, et al. Prenatal sonographic features of esophageal and ileal duplications at 18 weeks of gestation. Prenat Diagn. Dec 15 2004;24(12):969-71. [Medline].

  49. Dordelmann M, Rau G, Bartels D, et al. Evaluation of portal venous gas detected by ultrasound examination for diagnosis of NEC. Arch Dis Child Fetal Neonatal Ed. Sep 11. [Epub ahead of print] 2008.

  50. Faingold R, Daneman A, Tomlinson G, Babyn PS, Manson DE, Mohanta A. Necrotizing enterocolitis: assessment of bowel viability with color doppler US. Radiology. May 2005;235(2):587-94. [Medline].

  51. Ekenze SO, Mgbor SO. Childhood intussusception: the implications of delayed presentation. Afr J Paediatr Surg. Jan-Apr 2011;8(1):15-8. [Medline].

  52. Tareen F, Ryan S, Avanzini S, Pena V, Mc Laughlin D, Puri P. Does the length of the history influence the outcome of pneumatic reduction of intussusception in children?. Pediatr Surg Int. Jun 2011;27(6):587-9. [Medline].

  53. Whitehouse JS, Gourlay DM, Winthrop AL, Cassidy LD, Arca MJ. Is it safe to discharge intussusception patients after successful hydrostatic reduction?. J Pediatr Surg. Jun 2010;45(6):1182-6. [Medline].

  54. Kaiser AD, Applegate KE, Ladd AP. Current success in the treatment of intussusception in children. Surgery. Oct 2007;142(4):469-75; discussion 475-7. [Medline].

  55. Ramachandran P, Gupta A, Vincent P, et al. Air enema for intussusception: is predicting the outcome important?. Pediatr Surg Int. Mar 2008;24(3):311-3. [Medline].

  56. [Best Evidence] Abbas S, Bissett IP, Parry BR. Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev. Jul 18 2007;CD004651. [Medline].

  57. Rao SC, Basani L, Simmer K, Samnakay N, Deshpande G. Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants. Cochrane Database Syst Rev. Jun 15 2011;CD006182. [Medline].

  58. James DC, Lessen R. Position of the American Dietetic Association: promoting and supporting breastfeeding. J Am Diet Assoc. Nov 2009;109(11):1926-42. [Medline].

  59. Probiotics for prevention of necrotizing enterocolitis in preterm infants [database online]. Cochrane Database of Systematic Reviews: Al Faleh KM, Bassler D; 2008.

  60. Alfaleh K, Anabrees J, Bassler D, Al-Kharfi T. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. Mar 16 2011;CD005496. [Medline].

  61. Haque KN, Pammi M. Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates. Cochrane Database Syst Rev. Oct 5 2011;CD004205. [Medline].

  62. Kao C, Tseng SH, Chen Y. Laparoscopic reduction of intussusception in children by a single surgeon in comparison with open surgery. Minim Invasive Ther Allied Technol. May 2011;20(3):141-5. [Medline].

  63. Draus JM Jr, Foley DS, Bond SJ. Laparoscopic Ladd procedure: a minimally invasive approach to malrotation without midgut volvulus. Am Surg. Jul 2007;73(7):693-6. [Medline].

  64. Tsumura H, Ichikawa T, Murakami Y, et al. Laparoscopic adhesiolysis for recurrent postoperative small bowel obstruction. Hepatogastroenterology. Jul-Aug 2004;51(58):1058-61. [Medline].

  65. Sola JE, Tepas JJ 3rd, Koniaris LG. Peritoneal Drainage versus Laparotomy for Necrotizing Enterocolitis and Intestinal Perforation: A Meta-Analysis. J Surg Res. Jun 6 2009;[Medline].

  66. Banieghbal B, Beale PG. Minimal access approach to jejunal atresia. J Pediatr Surg. Aug 2007;42(8):1362-4. [Medline].

  67. Kozlov Y, Novogilov V, Yurkov P, Podkamenev A, Weber I, Sirkin N. Keyhole approach for repair of congenital duodenal obstruction. Eur J Pediatr Surg. Mar 2011;21(2):124-7. [Medline].

  68. Jawaheer J, Khalil B, Plummer T, et al. Primary resection and anastomosis for complicated meconium ileus: a safe procedure?. Pediatr Surg Int. Nov 2007;23(11):1091-3. [Medline].

 
Previous
Next
 
Small-bowel obstruction visible on plain radiograph caused by intussusception in a 5-month-old patient.
Barium enema revealing a coil spring appearance caused by the tracking of barium around the lumen of the edematous intestine in intussusception.
Small-bowel obstruction caused by an incarcerated inguinal hernia in a 2-month-old infant with bilateral inguinal hernias as well as an umbilical hernia.
Radiograph depicting the double-bubble sign characteristic of duodenal atresia.
Upper GI contrast study demonstrating a jejunal atresia with a proximal dilated atretic bowel and lack of passage of contrast into the distal small bowel.
Surgical photograph of the patient in the previous image depicting the proximal dilated atretic jejunum.
Upper GI contrast study showing a malrotation with lack of normal C-shaped duodenum and the small bowel "hanging" on the right side of the abdomen.
Contrast enema with an abnormally located cecum in a patient with malrotation.
Surgical photograph of necrotic bowel in a patient with midgut volvulus.
Necrotic bowel after surgical reduction of an intussusception.
Surgical photograph of a transition zone in an infant with small bowel obstruction.
Incarcerated left inguinal hernia.
Mesocolic hernia.
Surgical image of a laparotomy on a 7-month-old girl with ileocolic intussusception. An edematous and erythematous cecal appendix was found to be acting as a lead point.
Surgical image of a laparotomy on a 2-day-old female patient with congenital small bowel obstruction. A type I jejunal atresia without mesenteric gap and a grossly dilated proximal intestine is seen.
A barium enema on a 1-year-old male patient depicts an ileocolic intussusception.
Clinical photograph of a 5-month-old male patient with characteristic currant-jelly stools due to intussusception.
Plain abdominal film on a 3-day-old newborn depicting the classic double-bubble sign for duodenal atresia.
Contrast-enhanced upper gastrointestinal film showing a duodenal atresia on a 2-day-old newborn.
Surgical photograph of a 3-year-old male patient with an obstructive, noncommunicating ileal duplication.
Plain abdominal film of a 6-year-old male patient with MRCP (mental retardation and cerebral palsy), with organo-axial gastric volvulus. Note the grossly dilated and obstructed stomach. A gastrostomy feeding tube can be seen in place. Surgical staplers from a previous laparoscopic funduplication are seen near the diaphragmatic crura.
Surgical photograph of an 8-month-old patient with ileocolic intussusception.
Plain abdominal film of a premature baby born at 28 weeks of gestation with necrotizing enterocolitis. Note the "railroad sign" (neumatosis intestinalis) in the hepatic flexure and soap-bubbles in the descending colon.
Clinical image of a micro-premature baby boy with discoloration on the right lower quadrant of the abdomen, due to intestinal perforation secondary to necrotizing enterocolitis. An umbilical catheter is in place.
Plain abdominal film on a premature baby girl with necrotizing enterocolitis. Note the air in the biliary tree and the grossly dilated bowel.
Surgical photograph of a 1-year-old male patient who previously underwent a right radical nephrectomy for Wilms tumor. He presented to the emergency department with signs of a mechanical small bowel obstruction. A transition zone is clearly seen at the point where the small bowel is trapped on an internal hernia through a mesenteric gap.
Image of intussusception by ultrasound on a 9-month-old male patient.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.