ABSTRACT
BACKGROUND: Conservative treatment of postoperative small bowel obstruction in children is widely accepted, provided that there are no clinical signs of bowel strangulation. However, the length of time surgery can be safely deferred remains unclear. PURPOSE: The aim of this study was to determine the time limit for observant management of postoperative small bowel obstruction. METHODS: The medical records of 128 children with 174 episodes of postoperative small bowel obstruction were reviewed. RESULTS: Spontaneous resolution occurred in 63% of cases, 85% within 48 hours of admission. Bowel compromise was noted in 31% of the operated cases, and about half of them underwent bowel resection, accounting for 6% of all admissions. None of the cases treated surgically within 16 hours of admission was associated with bowel strangulation or need for resection. CONCLUSIONS: In children presenting with postoperative small bowel obstruction, prolonging observant treatment for more than 48 hours yields only a small benefit in terms of spontaneous resolution. Bowel strangulation can occur within 16 hours of admission. On the basis of these findings, we suggest raising the index of suspicion for compromised bowel after 16 hours and making the decision for surgery at around 48 hours.
Subject(s)
Intestinal Obstruction/therapy , Intestine, Small , Postoperative Complications/therapy , Child , Child, Preschool , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Observation , Postoperative Complications/surgery , Remission, Spontaneous , Retrospective Studies , Time FactorsABSTRACT
BACKGROUND: Wandering spleen (WS) is an uncommon condition with a variety of clinical presentations. METHODS: The medical files of 5 children who underwent operation for WS in the authors' department during the period 1996 through 2000 were retrospectively reviewed. RESULTS: Splenic salvage procedures (retroperitoneal splenopexy) were performed in 4 patients. One patient underwent splenectomy because of splenic necrosis. CONCLUSIONS: Early diagnosis and surgical treatment is mandatory to prevent complications. Every effort should be made to preserve the spleen, especially among the pediatric population, and splenopexy is the procedure of choice even in the asymptomatic patient.
Subject(s)
Splenic Diseases/diagnosis , Adolescent , Child , Child, Preschool , Female , Humans , Ligaments/abnormalities , Ligaments/physiopathology , Male , Splenic Diseases/etiology , Splenic Diseases/surgeryABSTRACT
Intestinal obstruction in the newborn is a potentially life-threatening complication. The most common causes are meconium plug, meconium ileus, intestinal atresia, intestinal malrotation, and Hirschprung's disease. We present an unusual case of intestinal obstruction caused by torsion of an ovarian cyst. The left fimbria and ovary swirled around the sigmoid colon, causing colonic stricture.
