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Gastrointestinal obstructions are categorized according to etiology as either congenital or acquired. These broad categories are not mutually exclusive. For example, congenital lesions of the intestine such as an enteric duplication or Meckel diverticulum may not cause obstruction until later in life. Congenital anatomic defects and acquired disorders of the intestine presenting in the first 30 days of life are characterized as neonatal intestinal obstruction.

Clinical Features and Differential Diagnosis

Neonatal Intestinal Obstruction

The anatomic conditions that present with neonatal intestinal obstruction and their diagnostic features are summarized in Table 389-1. Accurate diagnosis of neonatal intestinal obstruction relies on a thorough history, careful examination, and directed radiological studies.1 In a newborn infant, postprandial nonbilious emesis, or spitting up, is quite common and does not require urgent evaluation (see Chapter 394). In contrast, neonatal intestinal obstruction is usually characterized by feeding intolerance, abdominal distention, bilious emesis, and failure to pass meconium. Bilious emesis is most frequently a consequence of mechanical intestinal obstruction, and prompt evaluation is necessary to exclude life-threatening conditions such as necrotizing enterocolitis or volvulus. The history provides clues to the potential etiology of intestinal obstruction, but history and physical examination alone are generally not reliable for establishment of a diagnosis. For example, a 3-week-old infant with bilious emesis who has passed meconium and previously tolerated feeding is unlikely to have intestinal atresia as a cause of emesis and more likely to have intestinal malrotation with midgut volvulus. Infants with trisomy 21 are more likely to have congenital duodenal obstruction2 and Hirschsprung disease. Neonates with anomalies of vertebral, anorectal, cardiac, esophageal, renal, and limbs are more likely to have esophageal atresia and anorectal malformations as possible causes of intestinal obstruction (VACTERL association). Extremely low birthweight, premature infants are much more likely than term infants to develop necrotizing enterocolitis.

Table 389-1. Diagnostic Features of Anatomic Conditions Presenting as Neonatal Intestinal Obstruction

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