It is one of the most common malformations in the small intestine and is the main cause of intestinal obstruction in the newborn.
With intestinal stenosis, the intestine is not completely blocked, but the interior space (lumen) has become so narrow that it makes it difficult for nutrients to pass. Intestinal strictures are also sometimes called intestinal obstructions .
Bowel obstructions can almost always be removed with surgery, but the procedure carries some risk.
Intestinal stenosis in children
The small intestine is a very important part of the digestive tract, it is where we absorb most of the nutrients from the food we eat. But sometimes children may not be able to absorb all the nutrients their growing bodies require.
Intestinal stricture means that the child’s intestines have not formed properly. There may be areas of blockage that prevent nutrients from flowing through the digestive tract, or some sections may not be connected to each other.
During surgery, the surgeon meticulously removes as little of the intestine as is absolutely necessary, but sometimes repairing the blockage means that the child does not have enough small intestine to absorb all the nutrition his growing body needs. This condition is called short bowel syndrome.
Stenosis refers to a partial obstruction that causes a narrowing of the opening (lumen) of the intestine. Although this condition can affect any portion of the gastrointestinal tract, the portion most commonly affected is the small intestine.
Frequencies, symptoms, and diagnostic methods differ according to the site of intestinal involvement. However, children with all forms of intestinal atresia require surgical treatment.
Intestinal obstructions are increasingly being identified through prenatal ultrasounds. This imaging technique can indicate excess amniotic fluid ( polyhydramnios ), which is caused by failure of the intestine to properly absorb amniotic fluid.
There are different ways that your gut could become blocked:
- Part of your intestine can twist, which can close it up and prevent something from happening.
- Your intestine can become inflamed and swollen.
- Scar tissue or a hernia can make your intestine too narrow for something to happen.
- A tumor or other growth inside your intestine could block the passage.
- Damaged blood vessels leading to the intestine can cause some intestinal tissue to die.
- If the muscular walls of the intestine become paralyzed (cannot move), they cannot move anything.
- In many cases, inflammation, previous surgeries, or cancer can cause intestinal obstruction. It is more likely to happen in older people.
Bowel obstructions can occur in the small or large intestine, but are more likely to be found in the small intestine.
The most common causes are:
- Crohn’s disease .
- Colon cancer.
- Stomach cancer.
- Ovarian cancer.
- Scar tissue from surgery
- Radiation to the abdominal area.
- Advanced lung cancer, breast cancer, or melanoma that has spread to the intestine.
The first step in treating the patient is to form an accurate and complete diagnosis. If doctors suspect a bowel obstruction after your baby is born, tests will be done to see if there is an obstruction and, if so, determine its location.
These diagnostic tests can include:
- An x-ray or ultrasound of your baby’s abdomen.
- An upper gastrointestinal test.
- A lower GI test or barium enema.
Doctors may also perform imaging studies of the patient’s heart and kidneys to check for abnormalities that sometimes accompany intestinal obstructions.
If your doctor suspects intestinal stenosis, the patient will undergo the following diagnostic procedures after stabilizing:
Abdominal X-ray – In most cases, this can establish a diagnosis.
Lower GI series : This is a procedure that examines the rectum, large intestine, and lower part of the small intestine.
An X-ray contrast agent is administered into the rectum as an enema; This covers the inside of the intestines, allowing them to be seen on an X-ray.
An abdominal X-ray can show narrow areas (stenosis), obstructions, the width (caliber) of the intestine, and other problems.
Upper GI series : This procedure examines the organs in the upper part of the digestive system. It is particularly useful in cases where there is an upper intestinal obstruction (pyloric or duodenal atresia).
A liquid called barium, which shows up well on x-rays, is given by mouth or given through a small tube placed through the mouth or nose into the stomach. X-rays are then taken to evaluate the digestive organs.
Abdominal ultrasound , ultrasonography is an imaging technique used to view internal organs as they function and to assess blood flow through various vessels.
Gel is applied to the abdomen and a special wand called a transducer is placed on the skin. The transducer sends sound waves into the body that bounce off the organs and return to the ultrasound machine, producing an image on the monitor.
An image or video of the test is also created so that it can be reviewed later.
Due to the high percentage of patients born with intestinal stenosis and intestinal artery that also have associated, life-threatening abnormalities.
Echocardiography and other studies : Imaging of the heart and kidney regions can also be done after the patient stabilizes.
What are the symptoms of intestinal stricture?
The small intestine ranges in length from 10 to 28 feet, and is divided into three main sections: the duodenum, jejunum, and ileum.
Intestinal obstructions are generally classified according to where the absence, blockage, or narrowing is found in the patient’s intestine.
Obstruction in the duodenum is known as duodenal atresia / stenosis, and obstructions in the jejunum or ileum are called jejunoileal atresia / stenosis.
Jejunum obstruction can accompany poor bowel rotation, herniation, or abdominal wall defects that strangle the small intestine, interrupting its blood supply. Typically half of all babies with duodenal obstruction are born prematurely, and more than 30% have Down syndrome.
Between 50% and 75% have other abnormalities, often affecting other parts of the digestive system, the heart, or the kidneys. If your baby has a bowel obstruction, it is usually discovered within a day or two after birth.
Some notable symptoms are:
- It does not tolerate food.
- You are vomiting.
- Swollen abdomen
Treatment for patients with intestinal atresia and stricture require an operation, and the exact type of operation varies depending on the location of the obstruction.
Before the operation, the patient must be stabilized. Excess intestinal contents and gas that contribute to bloating (bloating) are removed through a tube that is placed into the stomach through the mouth or nose.
Removing air and fluid from the intestinal tract can prevent vomiting and aspiration, and reduce the risk of intestinal perforation. It also provides comfort to the person as abdominal swelling is relieved.
Intravenous fluids are given to replace vital electrolytes (minerals and salts in the bloodstream and body) and fluids that have been lost through vomiting.Once the patient is stabilized, surgery is performed to repair the blockage. .
The pyloric obstruction is opened and the stomach duct is repaired. The success of this operation is excellent. The length of the hospital stay is generally one to three weeks. However, the hospital stay is considerably longer for premature babies.
Duodenal atresia and stenosis are controlled by connecting the blocked segment of the duodenum to the portion of the duodenum just behind the obstruction.
Also, a tube may be temporarily placed through a surgical opening in the abdominal wall (gastrostomy) to drain the stomach and protect the airways. This tube can also be used for feeding if needed.
Surgery is often the best option for treating intestinal obstructions. During the surgery, the surgeon will make an incision in your baby’s abdomen and remove the affected part of the intestine, taking care to leave as much of your baby’s healthy intestine as possible.
The surgeon will then reconnect your baby’s intestines. If a child does not have enough small intestine, the remaining part tries to fix the problem on its own.
It inflates like a balloon, creating more surface area to attract nutrients. But this has an unfortunate side effect, the wider the intestine, the longer it takes for the body to move nutrients through it.
More time in the intestines means more time for bacteria that would normally be rapidly shed to multiply, increasing the patient’s chances of infection.
This approach exposes more usable surface area and also creates a narrower space, which keeps food moving through the patient’s digestive tract at an appropriate rate, carrying bacteria out of the body along with the rest of the body’s waste.
After surgery, the patient may be given a special, easy-to-digest diet through an IV, and the team will monitor them carefully to assess how well their intestines are healing.
When the time is right, she switches to fewer IVs and more oral or tube feedings, with the goal of completely weaning them.