A Study of Adhesive Small Bowel Obstruction in Children including its various Treatment Modalities

Abstract

Background: Adhesive small bowel obstruction is one of the leading emergencies encountered in paediatric surgery that needs early and effective management.

Objectives: The aim of our study was to analyse the age, aetiology, presentation, and various treatment modalities of adhesive small bowel obstruction in children.

Participants: Total of 80 children <14 years of age with clinical and radiological evidence of adhesive small bowel obstruction were included.

Study Design: Prospective-Retrospective Observational.

Methods: After detailed history and clinical examination, all the patients were subjected to Base-line Investigations and Abdominal radiograph. After confirmation of adhesive small bowel obstruction, the patients were kept nil-per-oral and resuscitated with intra-venous fluids. Strict monitoring of vitals and serial radiographs of abdomen, lactate levels and leucocyte count were made. Patients who didn’t respond to standard decompression therapy were subjected to 50-100ml Gastrografin. After radiographic confirmation of Gastrografin in the caecum along with improvement in clinical signs, oral feeding was initiated and patients were discharged. Those patients who didn’t respond to Gastrografin underwent adhesiolysis, The data was collected and analysed.

Results: The maximum patients were in age group between 3.6-7 years (47.5%) with a mean age of 9.04 years. 50% of our patients had history of Appendectomy follow-up by Exploratory Laparotomy for worm obstruction (17.5%), stoma formation/closure (12.5%), Ladd’s procedure (7.5%), Nissen’s fundoplication (5%), CDH Repair (5%) and gastroduodenal anastomosis for Duodenal atresia (2.5%). Vomiting (90%) was the most common symptom followed by pain abdomen (87.5%), Abdomen distention (65%) and constipation (62.5%). The blood lactate levels of non-operated and operated groups showed comparable results and statistically significant. The comparison between TLC levels of non-operated and operated groups showed comparable results.38(47.5%) of our patients were managed with standard decompressive therapy,18(22.5%) patients with Gastrograffin therapy and 24 (30%) with adhesiolysis. The comparison between Conservative group and GGF group showed comparable results.

Conclusion: Conservative management with standard decompressive therapy followed by use of water- soluble contrast agents is a safe and effective approach in managing acute small bowel obstruction in selected children without predictor signs of strangulation and bowel ischemia.