Small Bowel Obstruction

A small bowel obstruction is a birth defect that partially or fully blocks the fetus’ small intestine.

The condition occurs when the small intestine doesn’t form properly during fetal development. The blockage can occur in any part of the small intestine.

Small bowel obstructions prevent the baby’s intestine from functioning properly.

Types of Small Bowel Obstructions

The small intestine is made up of three segments:

• the duodenum – the top segment, which is connected to the stomach
• the jejunum – the middle and largest segment, where most nutrients are absorbed
• the ileum – the lowest part of the small intestine, which empties into the large intestine or colon

Small bowel obstructions are named based on where they occur in the small intestine in addition to the extent of the blockage.

Partial blockage (stenosis) – Most small bowel obstructions are partial blockages caused by an abnormal narrowing of the intestine, known as stenosis.

Complete blockage (atresia) – If the small bowel is completely blocked or closed off, the condition is known as atresia. In some cases, the blocked section may be disconnected from the rest of the intestine.

How does a small bowel obstruction affect my baby?

In the womb, the fetus swallows amniotic fluid which then flows through their digestive tract and is passed as urine into the amniotic sac. 

A blockage in the baby’s small intestine interferes with this process, causing a buildup of amniotic fluid in the uterus, a condition known as polyhydramnios. This excess amniotic fluid can cause the uterus to quickly enlarge, putting mother and baby at risk of serious complications. Increased fluid can lead to a need for amnioreduction and/or early delivery.

Cause

Small bowel obstructions are believed to occur when the blood supply to the fetal intestines is interrupted or reduced. The cause of this disruption in blood flow is unknown.

Diagnosis

Small bowel obstructions may be diagnosed during a routine prenatal ultrasound. The blockage may be detected by swelling in the small intestine just before the obstruction, where the fluid backs up, or by an enlarged uterus due to a buildup of amniotic fluid.

If an obstruction is suspected or diagnosed, you may be referred to a fetal center with specialized expertise in these birth defects. At Texas Children’s Fetal Center, we arrange for a detailed assessment by a team of specialists experienced in the diagnosis and treatment of small bowel obstructions, including maternal-fetal medicine (MFM) physicians, fetal imaging experts, neonatologists, pediatric surgeons and genetic counselors.

Additional testing may include:

• High-resolution anatomy ultrasound to evaluate the condition
• Ultra-fast MRI for a more detailed view of fetal anatomy
• Fetal echocardiogram to evaluate your baby’s heart
• Amniocentesis and chromosomal analysis to screen for associated genetic abnormalities

Following this thorough evaluation, our specialists will meet with you about your results, answer any questions you have, and discuss your baby’s treatment needs after birth.

In some cases, small bowel obstructions aren’t diagnosed until after birth.

Treatment During Pregnancy

You and your baby will be closely monitored throughout pregnancy with regular ultrasounds to assess fetal growth, amniotic fluid volume, and the risk of complications such as preterm labor.

If polyhydramnios occurs, amnioreduction (reduction of the amniotic fluid) or early delivery may be required for the health and safety of you and your baby.

Treatment to repair the intestinal defect takes place after birth.

Delivery

We recommend delivery at a hospital with the specialized expertise and resources required to treat babies with small bowel obstructions, including the highest level neonatal intensive care unit (NICU), if needed.

Delivery and postnatal care should be carefully planned and coordinated by a team of maternal-fetal medicine and pediatric specialists experienced in working together to treat these rare conditions, ensuring the best possible care every step of the way.

Our patients delivering at Texas Children’s Pavilion for Women, located inside Texas Children’s Hospital, benefit from seamless access to the critical care services and pediatric specialists who treat children with small bowel obstructions, avoiding transfers during the critical postnatal period. We work closely with Texas Children’s Gastroenterology, Hepatology and Nutrition service, ranked number two in the nation in gastroenterology and GI surgery by U.S. News & World Report. This means the pediatric experts responsible for treating the child after delivery have been an integral part of their care team since before birth.

Surgery After Birth

Babies born with a small bowel obstruction require surgery to repair the defect and restore normal bowel function. Surgery is typically performed within the first few days of birth.

The type of surgery depends on each baby’s specific defect and where it is located.

If the defect is a small narrowed section of the intestine, known as a stricture, the surgeon may remove that abnormal piece and sew the two ends of the intestine together.

In more extensive cases involving a long or severely damaged section of the intestine, the surgeon may create a temporary opening in the abdomen, known as a stoma, and bring part of the small intestine outside the body. This procedure reroutes intestinal contents to pass through the stoma, where it is collected in a pouch, giving the section of the damaged intestine time to heal. A second surgery will be performed to reconnect the intestine and close the stoma.

After surgery, the baby receives fluids and nutrition intravenously until normal bowel function is restored.

Postnatal Care

Babies with small bowel obstruction will need regular follow-ups to ensure proper intestinal function and appropriate growth and weight gain. In severe cases, long-term care and intestinal rehabilitation may be required.

Depending on your baby’s defect, his or her postnatal care team may include:

• Neonatologist
• Pediatric surgeon
• Pediatric anesthesiologist

Texas Children’s Intestinal Rehabilitation Clinic provides multidisciplinary services for the evaluation, treatment and long-term care of intestinal conditions such as congenital small bowl obstruction. For more information, call 832-822-3131.

Why Texas Children’s Fetal Center?

• A single location for expert maternal, fetal and pediatric care. At Texas Children’s Hospital, you and your baby receive the specialized care required for the diagnosis and treatment of small bowel obstruction all in one location, for highly coordinated care and treatment planning.
• A skilled, experienced team with proven outcomes. We have a dedicated team of maternal-fetal medicine specialists, fetal imaging experts, neonatologists, surgeons and others who work together to care for you and your baby, using proven protocols we’ve developed over the years. With their combined expertise and unified approach, this team offers the best possible care for these rare fetal conditions.
• We care for your child’s needs at every stage of life. Our comprehensive approach starts with your first prenatal visit and continues through delivery, postnatal care, and childhood, as needed, thanks to one of the nation’s leading teams of fetal and pediatric specialists.