Management of adhesive small bowel obstruction in children: A water-soluble contrast protocol and laparoscopic adhesiolysis

Resume.

Aim

to evaluate conservative management with a water-soluble contrast test and laparoscopic adhesiolysis for adhesive small bowel obstruction in children within a prognosis-based algorithm.

Methods

children with the adhesive form in a main group treated by the algorithm were compared with a control group; a contrast test of up to 24 hours guided conservative treatment, and failure prompted laparoscopic adhesiolysis.

Results

adhesive obstruction accounted for 37.3 % of cases overall and became the leading cause from the age of four years. Conservative treatment succeeded in 84.0 % of main-group children versus 62.1 % of controls, and recovery without surgery rose from 46.2 % to 70.0 % (p = 0.048); when conservative treatment failed, the time to surgery shortened from 25.6 to 12.4 hours.