Purpose or Case Report: Bowel obstruction in newborns are divided into high and low obstruction. High obstruction occurs before the proximal jejunum and comprise congenital causes including: atresia of the esophagus, stomach, duodenum or jejunum, duodenal stenosis from annular pancreas, duodenal web, malrotation without or without midgut volvulus and congenital abdominopelvic cysts or masses. Low obstruction occurs distal to the proximal jejunum and consist of congenital causes such as ileal and colonic atresia, anorectal malformation, Hirschsprung’s diseasem, congenital abdominopelvic cysts or masses. Other causes include meconium ileus or functional immaturity of the colon.

Bowel obstruction in older neonates and children includes congenital causes such as Meckel’s diverticulum, malrotation, congenital hernia as well as inflammatory conditions such as appendicitis and Inflammatory bowel disease. Other causes include hypertrophic pyloric stenosis, intussusception, adhesions, sigmoid volvulus and ingested foreign bodies.

Plain radiographs are often the first-line imaging modality for neonates and children presenting with suspected gastrointestinal pathology. A comprehensive radiographic approach along with sound knowledge of the common causes and imaging features of bowel obstruction in the various pediatric demographics will help facilitate timely and appropriate management and also prevent unnecessary further investigations. Additionally, differentiating between high and low bowel obstruction will help guide the next step in management.

The purpose of this education exhibit are to:
1. Review normal and abnormal bowel gas pattern on plain radiographs and associated intepretation pitfalls in newborns, older neonates and children.
2. Familiarise radiologists with common causes and radiographic features of bowel obstruction in newborns, older neonates and children. Illustrative cases for the above conditions will be shown. Relevant further investigations are also discussed.
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