The Treatment of Adhesive Small Bowel Obstruction in Children

ABSTRACT

BACKGROUND: Immediate operative management has been applied to infants and children with an attacks of adhesive small-bowel obstruction (ASBO), but this treatment has been controversial. We retrospectively reviewed 30 patients who were admitted from 1992 to 1996 because of adhesive small-bowel obstructions. METHODS: Immediate operation was reserved for the 7 patients that presented with fever and leukocytosis and /or localized abdominal tenderness or complete obstruction. The remaining 23 patients initially underwent conservative treatment. RESULTS: Although 20 episodes were cured with conservative treatment, 3 cases subsequently required surgical intervention. No adverse occurrences were observed during or after the delayed operations. Recurrence occurred in 3 cases after surgery and in 2 cases after conservative treatment. In the study, we found that the age at the recent laparotomy, the time elapsed between the recent laparotomy and the obstructive episode, and the primary condition necessitating the laparotomy correlated significantly with the success of conservative treatment. CONCLUSIONS: We conclude that in the treatment of ASBO in children, conservative treatment through the use of abdominal decompression, antibiotics, fluid-electrolytes, physical therapy, etc. has to be applied first for patients without significant evidence of strangulation and complete obstruction.