Current Management of Adhesive Small Bowel Obstructions in Children
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- Title: Current Management of Adhesive Small Bowel Obstructions in Children
- Author: Nathan S. Rubalcava, MD a,b, K. Elizabeth Speck, MD, MS, FACS a, *
- Publisher: Elsevier Inc
- Publication: 2022
- Language: English
- Pages: 15
- Format: PDF
- File size: 1.104 KB
- DOI: 10.1016/j.yapd.2022.03.002
Adhesive small bowel obstructions are a common cause of morbidity in children who underwent prior abdominal surgery. The concept of partial versus complete bowel obstruction is outdated and lacks precision to be clinically useful. Identifying patients with indications for immediate operative intervention is critical and must be recognized to limit morbidity. Clinical protocols and contrast challenge algorithms have attempted to identify patients that will resolve their bowel obstruction nonoperatively; there has been slow uptake in the pediatric patient population versus adults until recently. Incorporating predictive models and standardized contrast challenge protocols will help reduce interpractitioner variability and improve clinical outcomes.
Key points
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Adhesions occur after abdominal surgery as a component of normal healing and are the most common cause of a bowel obstruction. Importantly, if the patient has never had surgery, they very likely have another surgical source.
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The first key is to distinguish between patients requiring urgent surgical management and those who qualify for initial nonoperative management.
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Adhesive bowel obstructions in children can be safely evaluated and possibly even treated with a contrast challenge.
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A contrast challenge guides timely decision making for patients who are initially managed nonoperatively, with high predictive value to distinguish between patients who will ultimately require surgery and those who will not.
Introduction
Although there are numerous causes of bowel obstruction, this article aims to summarize the data and provide updates on postoperative adhesive small bowel obstruction (ASBO) in children . Although all patients with a bowel obstruction should be evaluated by a surgeon, a bowel obstruction in a child who has not had prior abdominal surgery should prompt relatively urgent pediatric surgical consultation as the cause is almost certainly surgical.
Historically, attempts were made to distinguish between a partial or complete bowel obstruction to guide the decision for immediate operation versus initial nonoperative management. Unfortunately, these clinical definitions are imprecise and, therefore, do not predict the risk for the obstruction-associated ischemia and necrosis that would require immediate operation [
]. Therefore, similar to the care of adults, management of pediatric ASBO has moved away from attempting to characterize the degree of obstruction and more toward defining clinical metrics that predict failure of nonoperative management ∗∗.
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