Pediatric emergency medicine trisk 3752 3752

FIGURE 116.5 A: Small bowel obstruction. Numerous dilated small bowel loops occupy the
midabdomen and have a stepladder configuration. Minimal air is seen in the rectum. B: Same
patient as in (A ). The upright abdominal roentgenogram shows numerous dilated loops in the
small bowel with differential fluid levels in one loop indicating mechanical bowel obstruction.

Current Evidence
In any child with persistent emesis, especially with bilious emesis, acute intestinal
obstruction must be considered. If the obstruction is high in the intestinal tract,
the abdomen does not become distended; however, with lower intestinal
obstruction there is generalized distension and diffuse tenderness, usually without
signs of peritoneal irritation. Only if the bowel perforates or vascular
insufficiency occurs will signs of peritoneal irritation be present. If complete
obstruction persists, bowel habits may change, leading to complete obstipation of
both flatus and stool. All patients with suspected bowel obstruction should have
radiographs of the abdomen in supine and upright (or lateral decubitus) views. In
patients with acute mechanical bowel obstruction, multiple dilated loops are
usually seen. Fluid levels produced by the layering of air and intestinal contents
are seen in the upright or lateral decubitus radiographs ( Fig. 116.5 ).

Intussusception
CLINICAL PEARLS AND PITFALLS