A Prospective Clinical Evaluation of Adhesive Small Bowel Obstruction in Infants and Children

Abstract

Background: Adhesive small bowel obstruction is a significant cause of postoperative morbidity in children. There are limited studies on the epidemiology and scope of conservative management for adhesive small bowel obstruction in children. The purpose of this study was to determine the presentation, risk factors, and management, including the role of Gastrografin, for adhesive small bowel obstruction in children. Methods: Between June 2015 and June 2020, 90 patients with an adhesive small bowel obstruction presented to our pediatric surgery department. Out of these, 10 patients underwent upfront surgery and were excluded, while the rest were put on conservative treatment. Patients who failed to improve after 24 hours of conservative management in the absence of signs of strangulation were administered Gastrografin. Patients were evaluated clinically and radiologically to determine the resolution of the obstruction. Results: The mean age was 9.04 ± 3.89 with sex a ratio of 2.6:1. Vomiting was the most symptom (90% cases), followed by pain abdomen (87.5%). Appendectomy (50%) and enterotomy for worm obstruction (17.5%) were the most common previous surgical procedures leading to acute small bowel obstruction. Recurrent obstruction was seen in 7.5% of the cases. Thirty eight (47.5%) patients were successfully managed conservatively by standard decompression therapy. Oral administration of Gastrografin successfully resolved the obstruction in 43% patients who failed standard decompression therapy, whereas 24 (30%) patients with persistent obstruction required laparotomy. Conclusion: Adhesive small bowel obstruction is a common surgical emergency in children. It can occur at any age and after laparotomy for any surgical condition; however, history of appendectomy is associated with high incidence of adhesion obstruction. Vomiting and abdominal pain are constant symptoms. Conservative management with standard decompressive therapy followed by using water-soluble contrast agents (Gastrografin) is a safe and effective approach in managing adhesion obstruction in selected children without signs of bowel ischemia.