early in the postoperative course or months or even years later The child often has the sudden onset of abdominal cramps, nausea, vomiting, and abdominal distension Although most intestinal obstructions from adhesions not jeopardize the perfusion of the bowel, occasionally a loop of intestine, caught under a fibrous band or herniating through the adhesion, can become gangrenous All such patients need to be admitted to the hospital and evaluated by a surgeon who should direct the complete management Chronic Partial Intestinal Obstruction Any child with intermittent abdominal distension, nausea, anorexia, occasional vomiting, or chronic constipation or obstipation may have partial intestinal obstruction A number of diagnostic considerations exist TABLE 116.3 DIFFERENTIAL DIAGNOSIS OF FUNCTIONAL CONSTIPATION AND HIRSCHSPRUNG DISEASE Functional constipation Hirschsprung disease Onset History