Wednesday, May 30, 2012

Neonatal Low Bowel Obstruction Differential Diagnosis

Today's Daily Diff concerns low or large bowel obstruction in the neonate. The clinical differential diagnosis of a neonate with low intestinal obstruction is anorectal malformations, Hirschsprung disease, meconium ileus, functional immaturity of the colon, and distal intestinal atresia. To keep the diagnoses in mind, just remember HAMM:

DiseaseNotes
HHirschsprung disease
  • most common cause
  • caused by lack of ganglion cells in distal colon/rectum
  • colon dilates over time
AAtresia (anal; distal intestinal)
  • can be part of VACTERL syndrome
  • often there is fistula between distal bowel and bladder or perineum
MMeconium ileus
  • associated with cystic fibrosis
  • meconium abnormal
MMeconium plug syndrome
  • aka small left bowel syndrome
  • transient; meconium normal

While other entities can also cause bowel obstruction, the ones listed above cover the majority of the causes. In preterm babies, necrotizing enterocolitis is a major consideration. In an older population, the differential changes for bowel obstruction in children.

Meconium plug syndrome
Source: Radiopaedia
References: