Pediatric Radiology

, Volume 43, Issue 3, pp 318–329 | Cite as

A pattern-based approach to bowel obstruction in the newborn

  • Charles M. MaxfieldEmail author
  • Brett H. Bartz
  • Jennifer L. Shaffer


Intestinal obstruction is common in newborns, and the radiologist plays a critical role in the care of these children. Diagnosing and managing the potentially obstructed newborn can be challenging, especially given the myriad underlying pathologies that range from benign to acutely life-threatening. A familiarity with the most common diagnoses is essential, but equally important to the radiologist is a systematic approach to management of the child in this setting. We propose an approach based on the recognition of eight radiographic patterns, five upper gastrointestinal examination (UGI) patterns and four contrast enema patterns. Recognition of these patterns directs further imaging when necessary and allows triage of children who can be managed medically, those requiring elective or urgent surgery and those requiring emergent surgery.


Newborn Neonatal Obstruction Gastrointestinal 


Conflicts of interest



  1. 1.
    Shew S (2009) Surgical concerns in malrotation and midgut volvulus. Pediatr Radiol 39:167–171CrossRefGoogle Scholar
  2. 2.
    Grob M (1960) Intestinal obstruction in the newborn infant. Arch Dis Child 35:40–50PubMedCrossRefGoogle Scholar
  3. 3.
    Bailey PV, Tracy TF Jr, Connors RH et al (1993) Congenital duodenal obstruction: a 32-year review. J Pediatr Surg 28:92–95PubMedCrossRefGoogle Scholar
  4. 4.
    Dalla Vecchia LK, Grosfeld JL, West KW et al (1998) Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg 133:490–497PubMedCrossRefGoogle Scholar
  5. 5.
    Klein MD, Coran AG, Wesley JR et al (1984) Hirschsprung’s disease in the newborn. J Pediatr Surg 19:370–374PubMedCrossRefGoogle Scholar
  6. 6.
    Skupski DW (1998) Prenatal diagnosis of gastrointestinal anomalies with ultrasound: what have we learned? Ann N Y Acad Sci 847:53–58PubMedCrossRefGoogle Scholar
  7. 7.
    Phelps S, Fisher R, Partington A et al (1997) Prenatal ultrasound diagnosis of gastrointestinal malformations. J Pediatr Surg 32:438–440PubMedCrossRefGoogle Scholar
  8. 8.
    Berdon WE, Baker DH, Bull S et al (1970) Midgut malrotation and volvulus. Radiology 96:375–383PubMedGoogle Scholar
  9. 9.
    Traubici J (2001) The double bubble sign. Radiology 220:463–464PubMedGoogle Scholar
  10. 10.
    Gilberston-Dahdal DL, Dutta S, Varich LJ et al (2009) Neonatal malrotation with midgut volvulus mimicking duodenal stenosis. AJR 192:1269–1271CrossRefGoogle Scholar
  11. 11.
    Pumberger W, Birnbacher R, Romberger G et al (2002) Duodeno-jejunal atresia with volvulus, absent dorsal mesentery, and absent superior mesenteric artery: a hereditary compound structure in duodenal atresia? Am J Med Genet 109:52–55PubMedCrossRefGoogle Scholar
  12. 12.
    Swischuk LE (2010) Double-bubble sign. AJR 195:W253PubMedCrossRefGoogle Scholar
  13. 13.
    Samuel M, Wheeler RA, Mami AG (1997) Does duodenal atresia and stenosis prevent midgut volvulus in malrotation? Eur J Pediatr Surg 7:11–12PubMedCrossRefGoogle Scholar
  14. 14.
    Moore CC (1989) Congenital gastric outlet obstruction. J Pediatr Surg 24:1241–1246PubMedCrossRefGoogle Scholar
  15. 15.
    Rathaus V, Grunebaum M, Ziv N et al (1992) The bubble sign in the gasless abdomen of the newborn. Pediatr Radiol 22:106–109PubMedCrossRefGoogle Scholar
  16. 16.
    Louw JH, Barnard CN (1955) Congenital intestinal atresia. Observations on its origin. Lancet 266:1065–1067CrossRefGoogle Scholar
  17. 17.
    Astley R (1969) Duodenal atresia with gas below the obstruction. Brit J Radiol 42:351–353PubMedCrossRefGoogle Scholar
  18. 18.
    Donnison AB, Shwachman H, Gross RE (1966) A review of 164 children with meconium ileus seen at the Children’s Hospital Medical Center, Boston. Pediatrics 37:833–850PubMedGoogle Scholar
  19. 19.
    Frye TR, Mah CL, Schiller M (1972) Roentgenographic evidence of gangrenous bowel in midgut volvulus with observations in experimental volvulus. AJR Am J Roentgenol Radium Ther Nucl Med 114:394–401Google Scholar
  20. 20.
    Maheshwari A, Carlo WA (2011) Digestive system disorders. In: Kliegman RM, Stanton BF, St. Geme JW et al (eds) Nelson textbook of pediatrics, 19th edn. Elsevier, Philadelphia, pp 600–601CrossRefGoogle Scholar
  21. 21.
    Katz ME, Siegel MJ, Shackelford GD et al (1987) The position and mobility of the duodenum in children. AJR 148:947–951PubMedGoogle Scholar
  22. 22.
    Long FR, Kramer SS, Markowitz RI et al (1996) Intestinal malrotation in children: tutorial on radiographic diagnosis in difficult cases. Radiology 198:775–780PubMedGoogle Scholar
  23. 23.
    Ortiz-Neira CL (2007) The corkscrew sign: midgut volvulus. Radiology 242:315–316PubMedCrossRefGoogle Scholar
  24. 24.
    Eustace S, Connolly B, Blake N (1993) Congenital duodenal obstruction: an approach to diagnosis. Eur J Pediatr Surg 3:267–270PubMedCrossRefGoogle Scholar
  25. 25.
    Berdon WE, Baker DH, Santulli TV et al (1968) Microcolon in newborn infants with intestinal obstruction. Radiology 90:878–885PubMedGoogle Scholar
  26. 26.
    Fakhoury K, Durie PR, Levison H et al (1992) Meconium ileus in the absence of cystic fibrosis. Arch Dis Child 67:1204–1206PubMedCrossRefGoogle Scholar
  27. 27.
    Noblett HR (1969) Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report. J Pediatr Surg 4:190–197PubMedCrossRefGoogle Scholar
  28. 28.
    Stranzinger E, DiPietro MA, Teitelbaum DH et al (2008) Imaging of total colonic Hirschsprung disease. Pediatr Radiol 38:1162–1170PubMedCrossRefGoogle Scholar
  29. 29.
    Karnak İ, Ciftci AO, Şenocak ME et al (2001) Colonic atresia: surgical management and outcome. Pediatr Surg Int 17:631–635PubMedCrossRefGoogle Scholar
  30. 30.
    Keckler SJ, Yang JC, Fraser JD et al (2009) Contemporary practice patterns in the surgical management of Hirschsprung’s disease. J Pediatr Surg 44:1257–1260PubMedCrossRefGoogle Scholar
  31. 31.
    Ellis H, Kumar R, Kostyrka B (2009) Neonatal small left colon syndrome in the offspring of diabetic mothers: an analysis of 105 children. J Pediatr Surg 44:2343–2346PubMedCrossRefGoogle Scholar
  32. 32.
    Stewart DR, Nixon GW, Johnson DG et al (1977) Neonatal small left colon syndrome. Ann Surg 186:741–745PubMedCrossRefGoogle Scholar
  33. 33.
    George Kassner E, Kottmeier PK (1975) Absence and retention of small bowel gas in infants with midgut volvulus: mechanisms and significance. Pediatr Radiol 4:28–30CrossRefGoogle Scholar
  34. 34.
    N-Fekete C, Ricour C, Martelli H et al (1986) Total colonic aganglionosis (with or without ileal involvement): a review of 27 cases. J Pediatr Surg 21:251–254PubMedCrossRefGoogle Scholar
  35. 35.
    Smith GHH, Cass D (1991) Infantile Hirschsprung’s disease—is a barium enema useful? Pediatr Surg Int 6:318–321Google Scholar
  36. 36.
    Amodio J, Berdon W, Abramson S et al (1986) Microcolon of prematurity: a form of functional obstruction. AJR 146:239–244PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Charles M. Maxfield
    • 1
    Email author
  • Brett H. Bartz
    • 1
  • Jennifer L. Shaffer
    • 1
  1. 1.Department of RadiologyDuke University Medical CenterDurhamUSA

Personalised recommendations