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Key Features

  • Most common surgical emergency seen in neonates

  • A history of polyhydramnios is common, and the fluid, if bile-stained, can easily be confused with thin meconium staining

  • The higher the location of the obstruction in the intestine, the earlier vomiting develops and the less prominent the abdominal distention will be

  • Lower intestinal obstruction presents with abdominal distention and later onset of emesis

  • Malrotation with midgut volvulus

    • Surgical emergency

    • Appears in the first days to weeks as bilious vomiting without distention or tenderness

    • If not treated promptly, torsion of the intestine around the superior mesenteric artery leads to necrosis of the entire small bowel

Clinical Findings

  • Emesis presents soon after birth in infants with high intestinal obstruction

  • Bilious emesis suggests intestinal malrotation with midgut volvulus until proved otherwise

  • Low intestinal obstruction is characterized by abdominal distention and late onset of emesis, often with delayed or absent stooling


  • Depends on plain abdominal radiographs with either upper GI series (high obstruction suspected) or contrast enema (lower obstruction apparent) to define the area of obstruction

  • Radiographic findings of gaseous distention should prompt contrast enema to diagnose (and treat) meconium plug syndrome


  • Orogastric (OG) suction to decompress the bowel, intravenous glucose, fluid and electrolyte replacement, and respiratory support as necessary

  • Antibiotics are usually indicated in the setting of bowel distention due to risk of bacterial translocation

  • Surgery is definitive treatment for these conditions (with the exception of meconium plug syndrome, small left colon syndrome, and some cases of meconium ileus)

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