UPSC-CMS 2016 — Pediatrics

Q: What is the most common cause of intestinal obstruction in neonates?

Duodenal atresia. ***Duodenal atresia*** - **Duodenal atresia** is one of the **most common causes of intestinal obstruction** in neonates, accounting for approximately 30-40% of all neonatal intestinal obstructions. - It is a **congenital malformation** where the duodenum is completely blocked, leading to the characteristic **"double-bubble" sign** on X-ray (one bubble in the stomach and one in the proximal duodenum). - Strongly associated with **Down syndrome** (30% of cases) and **polyhydramnios** during pregnancy. - Presents with **bilious vomiting** within the first 24-48 hours of life. *Meconium ileus* - **Meconium ileus** accounts for only **10-15%** of neonatal intestinal obstruction cases. - It is strongly associated with **cystic fibrosis** (90% of meconium ileus cases have CF), with approximately 10-20% of CF newborns presenting with meconium ileus. - Caused by thick, inspissated meconium obstructing the terminal ileum. *Hirschsprung's disease* - **Hirschsprung's disease** causes functional obstruction due to **absence of ganglion cells** in the distal bowel (aganglionic segment). - Accounts for **15-20%** of neonatal intestinal obstruction cases. - Typically presents with **delayed passage of meconium** (>48 hours), abdominal distension, and bilious vomiting. *Volvulus neonatorium* - **Volvulus neonatorium** involves twisting of the intestine, often due to **intestinal malrotation**, leading to obstruction and vascular compromise. - Accounts for **10-15%** of cases and presents as a surgical emergency with bilious vomiting and potential bowel ischemia. [Practice more Pediatrics PYQs on OnCourse]

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What is the most common cause of intestinal obstruction in neonates?

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