Adhesive small bowel obstruction in children: should we still operate?

Purpose: Adhesive small bowel obstruction (ASBO) is a significant cause of postoperative morbidity, yet studies characterizing outcomes in children are limited. Our aim was to review our experience to describe the role of operative and nonoperative therapy, markers of outcome, and burden of disease in children.

Materials and methods: Admissions for ASBO at British Columbia Children's Hospital (Vancouver, British Columbia, Canada) identified by International Classification of Disease, Ninth Revision, codes were reviewed over a 10-year period. Demographic, clinical, laboratory, and operative details were collected for all patients.

Results: Our study identified 165 admissions of which 32 (19%) were managed with immediate operation, whereas 133 were initially managed nonoperatively. One hundred seven patients went on to laparotomy, whereas 26 (16%) were managed nonoperatively. Absence of leukocytosis and older age appeared to be associated with successful nonoperative therapy. Tachycardia and younger age appeared to be independent risk factors for failure of nonoperative management. Delayed surgery or conservative management did not cause an increase in complications. Appendectomy, stoma formation and closure, Nissen fundoplication, and Ladd's procedures were the most common procedures leading to ASBO.

Conclusions: Conservative therapy is the preferred approach in selected patients with ASBO. However, 84% eventually require surgery. This differs markedly from results in adults where most resolve nonoperatively. Younger patients were more likely to fail conservative trials and were more likely to develop advanced disease, pointing to ASBO as a distinct disease entity in children.