Conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water- soluble contrast protocol

Abstract

Background/purposeWe compare the outcomes of conservative management of adhesive small bowel obstruction (ASBO) before and after the implementation of an enteral hyperosmolar water-soluble contrast protocol. MethodsWe performed a retrospective chart review of all patients with ASBO admitted into the Hospital de Niños de la Santísima Trinidad (Córdoba, Argentina) between June 2017 through June 2022. Patients admitted before June 2020 (group 1) received traditional conservative management (no enteral feeding, gastric decompression, and intravenous hydroelectrolytic resuscitation). Surgery was indicated at the discretion of the treating surgeon. Patients admitted after June 2020 (group 2) received water-soluble contrast 12–24 h after admission. Surgery was indicated if contrast agent was not seen in the colon in a radiographic examination 24 h after the administration, or if symptoms persisted despite the presence of contrast in the colon and in case of clinical worsening or protocol discontinuation. Group outcomes were compared. Surgical rate was the main outcome. ResultsFifty-three episodes of ASBO were included. Surgical treatment was indicated in 80 % of group 1 and in 66 % of group 2 (p = 0.28). The sensitivity and specificity of hyperosmolar water-soluble contrast to predict the success of conservative management were 100 % and 60 %, respectively. The complication rate after contrast administration was 66.66 %. Vomiting was the most common complication. ConclusionsHyperosmolar water-soluble contrast did not significantly decrease the rate of surgical procedures. However, it is a sensitive tool predicting the success of conservative management and is not associated with the occurrence of major complications. Level of evidenceLevel III Type of studyRetrospective comparative study.