Type of obstruction	Cause and incidence	Age of onset and presentations	Diagnostic procedure and findings	Preoperative management interval before surgery	Treatment	Postoperative management	Prognosis
Duodenal atresia	Embryogenic; occurs in 1 per 5,000 live births; 25% have Down syndrome	Few hours after birth; bilious vomiting, no distention	Abdominal film, “double-bubble” sign	Nasogastric suction, IV fluids; 24 to 48 hours	Diamond-shaped duodenoduodenostomy	No oral intake, nasogastric suction; feeding at 2 to 3 days after surgery	Good unless associated with serious anomalies
Malrotation with volvulus	Incomplete bowel rotation occurring during 7th to 12th weeks of gestation	At 3 to 7 days; bilious vomiting, rapid deterioration with volvulus	Upper GI spiral sign on ultrasound; abnormal location of the superior mesenteric vessels	Nasogastric suction, IV fluid; STAT surgery for symptomatic patients, within daysfor others	Ladd's procedure; may require a second laparotomy	No oral intake; nasogastric suction	Good without bowel resection, difficult with short-gut syndrome after bowel resection
Jejunoileal atresia	Mesenteric vascular accident during fetal life in 1 per 3,000 live births	Within 24 hours of birth; vomiting, abdominal distention	Air-fluid levels on abdominal film	Nasogastric suction, IV fluids; 12 to 24 hours	Resection(s) and anastomosis(es)	No oral intake, nasogastric suction; feeding at 2 to 4 days after surgery	Good unless excessive loss of bowel
Meconium ileus	Genetic, occurs in 15% of newborns with cystic fibrosis, and in 1 per 5,000 to 10,000 live births	Immediately after birth; abdominal distention, bilious vomiting	Abdominal film; distention, air-fluid levels, sweat test, “ground-glass” sign	Decompression	Enterostomy if complicated; Gastrografin enema plus IV fluids	Acetylcysteine (Mucomyst), pancreatic enzymes	Depends on the systemic problems
Necrotizing ileus	Cause unknown in 2.4 per 1,000 live births	10 to 12 days after birth; distention, vomiting, bloody stools	Abdominal film; distention, pneumatosis, air in the aortal vein	Nasogastric suction, IV fluids, nutrition, antibiotics for 10 days. When perforated, immediate surgery	Resection of necrotic bowel and enterostomy	Same as preoperative management	25% need surgery (65% survival rate) 75% can be treated medically (95% survival rate)