Non-operative Management of Adhesive Intestinal Obstruction in Children over a 12 year period at Waikato Hospital

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Aaron Ooi
Jitoko Kelepi Cama
Udaya Samarakkody
Askar Kukkady
Stuart Brown


Bowel Obstruction, paediatric surgery


Title: Non-Operative Management of Adhesive Intestinal Bowel Obstruction in Children over a 12year Period at Waikato Hospital

Introduction: Post-operative small bowel adhesions causing bowel obstruction is common in adults but is uncommon in the paediatric age group. The incidence of adhesive intestinal obstruction (AIO) requiring surgical intervention ranges between 2-8% in paediatric patients and majority would occur within the first 2 years after surgery.

Aim: To review our experience at a tertiary centre in children under 15years who were admitted with adhesive intestinal obstruction over a 12 year time period and to compare this with other international reports

Methodology: This retrospective case series study of all paediatric surgical patients (aged between 1-15 years) admitted with adhesive intestinal obstruction to Waikato Hospital over a 12 year time period were identified by ICD-10-AM codes. Their demographic variables, information of previous surgery and the admissions details including particulars of management were tabulated.

Results: Out of 66 admissions, 10 were excluded and 56 admissions were analysed. 35 patients were successfully managed non-operatively and 21 patients proceeded for operative management (7 early and 14 late). Of the operative group, 3 underwent bowel resections (2 early and 1 late). There was no statistically significant difference between length of stay (LOS) among patients with non-operative and operative management. There was also no statistically significant difference between LOS among patients with early (?24 hours) operative management and late (>24 hours) operative management. In assessing secondary aims, statistically significant differences in the time of presentation from initial surgery was noted for patients who underwent appendectomy who trended towards earlier presentation compared to other laparotomies.

Conclusion: This study demonstrated that there could still be a role of non-operative management of children with adhesive bowel obstruction but decision on further management should be clearly defined within 24hours to prevent development of complications.

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1. Menzies D, E. H. (1990). Intestinal obstruction from adhesions: How big is the problem? Annals of the Royal College of Surgeons of England, 72, 60-63.
2. Grant HW, P. M. (2006). Population-based analysis of the risk of adhesion-related readmissions after abdominal surgery in children. Journal of Pediatric Surgery, 41, 1453-1456.
3. Choudhry MS, G. H. (2006). Small bowel obstruction due to adhesions following neonatal laparotomy. Pediatric Surgery International, 22, 729-732.
4. Festen C. (1982). Postoperative small bowel obstruction in infants and children. Annals of Surgery, 196, 580-3.
5. Eeson GA, W. P. (2010). Adhesive small bowel obstruction in chidlren: Should we still operate? Journal of Pediatric Surgery, 45(5), 969-74.
6. Vijay K, A. C. (2005). Adhesive small bowel obstruction in children - the role of conservative management. Medical Journal of Malaysia, 60(1), 81-4.
7. Akgur FM, T. F. (1991). Adhesive small bowel obstruction in children: The place and predictors of success for conservative management. Journal of Pediatric Surgery, 26, 37-41.
8. Alwan MH, v. R. (1999). Postoperative adhesive small bowel obstruction: The resource impacts. The New Zealand Medical Journal, 12(1099), 421-423.
9. Al-Salem AH, O. M. (2011). Adhesive intestinal obstruction in infants and children: The place of conservative treatment. International Scholarly Research Network Surgery.
10. Grant HW, P. M. (2008). Adhesions after abdominal surgery in children. Journal of Pediatric Surgery, 43, 152-7.
11. Shieh CS, C. J. (1995). Adhesive small bowel obstruction in children. Pediatric Surgery International, 10, 339-341.
12. Liakakos T, T. N. (2001). Peritoneal adhesions: Etiology, pathophysiology and clinical significance. Digestive Surgery(18), 260-273.
13. Inoue M, U. K. (2005). Efficacy of Seprafilm for reducing reoperative risk in pediatric surgical patients undergoing abdominal surgeyr. Journal of Pediatric Surgery, 40(8), 1301-6.
14. Kumar S, W. P. (2009). Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological
15. abdominal surgery . Cochrane Database of Systematic Reviews .
16. Feigin E, K. D. (2010). The 16 golden hours for conservative treatment in children with postoperative small bowel obstruction. Journal of Pediatric Surgery, 45, 966-8.
17. Seror D, F. E. (1993). How conservatively can postoperative small bowel obstruction be treated? The American Journal of Surgery, 165, 121-6.
18. Janik JS, E. S. (1981). An assessment of the surgical treatment of adhesive small bowel obstruction in infants and children. Journal of Pediatric Surgery, 16, 37-41.
19. Lautz TB, R. M. (2011). Adhesive small bowel obstruction in children and adolescents: Operative utilisation and factors associated with bowel loss. Journal of the American College of Surgeons, 212(5), 855-861.