Non-operative Management of Adhesive Intestinal Obstruction in Children over a 12 year period at Waikato Hospital

Abstract

Title: Non-Operative Management of Adhesive Intestinal Bowel Obstruction in Children over a 12year Period at Waikato HospitalIntroduction: Post-operative small bowel adhesions causing bowel obstruction is common in adults but is uncommon in the paediatric age group. The incidence of adhesive intestinal obstruction (AIO) requiring surgical intervention ranges between 2-8% in paediatric patients and majority would occur within the first 2 years after surgery.
 Aim: To review our experience at a tertiary centre in children under 15years who were admitted with adhesive intestinal obstruction over a 12 year time period and to compare this with other international reports
 Methodology: This retrospective case series study of all paediatric surgical patients (aged between 1-15 years) admitted with adhesive intestinal obstruction to Waikato Hospital over a 12 year time period were identified by ICD-10-AM codes. Their demographic variables, information of previous surgery and the admissions details including particulars of management were tabulated.
 Results: Out of 66 admissions, 10 were excluded and 56 admissions were analysed. 35 patients were successfully managed non-operatively and 21 patients proceeded for operative management (7 early and 14 late). Of the operative group, 3 underwent bowel resections (2 early and 1 late). There was no statistically significant difference between length of stay (LOS) among patients with non-operative and operative management. There was also no statistically significant difference between LOS among patients with early (≤24 hours) operative management and late (>24 hours) operative management. In assessing secondary aims, statistically significant differences in the time of presentation from initial surgery was noted for patients who underwent appendectomy who trended towards earlier presentation compared to other laparotomies.
 Conclusion: This study demonstrated that there could still be a role of non-operative management of children with adhesive bowel obstruction but decision on further management should be clearly defined within 24hours to prevent development of complications.