An assessment of the surgical treatment of adhesive small bowel obstruction in infants and children

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At The Hospital for Sick Children, Toronto, Canada, adhesive small bowel obstruction (SBO) ranks seventh as a cause of pediatric bowel obstruction. Between January 1968 and December 1979, 131 infants and children had adhesive SBO proven at laparotomy or autopsy: 123 had 1; 7 had 16 adhesiotomies; 1 died without surgery; 100 had 1 prior operation; and 31 had multiple operations. Over 80% of the SBOs developed within 2 yr of the prior operations. Appendectomy and subtotal colectomy were the most common prior operation. Postoperative morbidity occurred in 29 children; 20 were observed longer than 24 hr before laparotomy. The rate of wound infection ranged from 4% to 50%; it was lowest for those children who had lysis of adhesions only, and highest for those who had lysis and decompressive enterotomy or perforation repair. Results indicate that delaying adhesiotomy and entering the GI tract during adhesiotomy are associated with increased morbidity (p<0.01), and therefore should be avoided. Prophylactic antibiotics may have a protective role during enterolysis.

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Presented before the 29th Annual Meeting of the Surgical Section of the American Academy of Pediatrics, Detroit, Michigan, October 27–28, 1980.

1

From the Division of general Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.

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