K. L. Weaver1, H. Alemayehu1, B. David1, S. D. St. Peter1, P. Aguayo1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Kansas City, MO, USA
Introduction:
Small bowel obstruction (SBO) remains a significant source of morbidity and accounts for up to 16% of surgical admissions in the US. Despite this prevalence, literature relevant to the management of pediatric SBO is sparse. We reviewed our institutional experience to determine the etiologies, clinical course, management and outcomes of pediatric SBO.
Methods:
With IRB approval, we conducted a retrospective review of all patients <18yrs admitted for SBO from 2008 through 2013. Patients with a history of chronic obstruction, known intestinal dysmotility, colonic obstruction, neonatal SBO, or acute ileocolic intussusception were excluded. Patients with inflammatory bowel strictures were included only if they presented acutely. Both descriptive and comparative analysis was performed. All means reported ± standard deviation.
Results:
There were 156 patients with acute SBO during the study period; 73 male and 83 female. 42 children had 57 recurrent SBOs for a recurrence rate of 27% after a single episode of SBO. Overall there were 213 episodes of SBO. The mean age at SBO was 8.1 ± 6.0 years. Overall 79% (n=169) underwent operative management. 69% (n=148) of the episodes of SBO had prior abdominal surgery, and 85% (n=126) were managed operatively; adhesions were the most common etiology (n=86). Mean time from previous operation to initial episode of SBO was 33.2 ± 46.1 months. Children without previous abdominal surgery had obstructions due to intestinal strictures (n=11), perforated appendicitis (n=8), Meckel’s Diverticulum (n=7), congenital adhesions (n=7), volvulus (n=1), and other causes (n=9). Non-operative management with bowel rest and nasogastric tube decompression was attempted in 51% (n=108) of patients. Non-operative management failed in 59% of these patients, 62% of which had adhesive bowel obstructions. Recurrent SBO after successful non-operative management was 39% which was higher than those who underwent operative management who had a recurrence rate of 19% (p=0.01).
Conclusion:
Non-operative management of SBOs in children has a higher failure rate than reported in adults. Further, those who succeed with conservative management have a higher rate of recurrence than those who undergo exploration.