STRANGULATION PREDICTION FACTORS IN CHILDREN WITH ADHESIVE INTESTINAL OBSTRUCTION

Abstract

Introduction. Adhesive small bowel obstruction (ASBO) remains one of the leading causes of emergency surgery in children. According to various authors, the incidence of ASBO remains high (in 2-6% of children after abdominal surgery), despite the introduction of minimally invasive technologies and modern means of prevention.
 Objective: To improve the treatment outcomes of patients with ASBO by identifying strangulation prediction factors to determine the indications for urgent surgery.
 Material and methods. We have analyzed the prognostic value of clinical-anamnestic and paraclinical features in 89 children with ASBO which may be pathogenetically associated with the presence of strangulation. 75.3% of them (67 patients) had obstructive ASBO nature, and 24.7% (22) had strangulation. The analysis was performed using conjugation tables and Pearson's χ2 criteria. The connection was considered reliable at p <0,05.
 Results. We have determined 8 signs which demonstrated the presence of a statistically significant connection with the strangulation nature of obstruction, among which the greatest prognostic value (p≤0.001) had positive peritoneal signs (χ2 = 15.256), free fluid in the abdominal cavity during ultrasound monitoring of the pelvis (χ2 = 13.777) and in the form of inter-loop effusion (χ2 = 6.473). From laboratory data it is necessary to pay attention to the existence of a hyperleukocytosis (52,6%). These signs, identified as a result of the study, can be obtained quickly and easily at the initial examination of a patient and allow to effectively assess the likelihood of strangulation obstruction and, accordingly, to assist in making a clinical decision.
 Conclusion. For timely diagnosis of irreversible intestinal wall changes at strangulation obstruction, ultrasound examination of abdominal organs should be performed immediately upon treatment or hospitalization of a child with ASBO to avoid intestinal damage due to strangulation and development of peritonitis. The presence of 2 or more of the identified prognostic factors (89.5%) in children with ASBO means a "strong" connection with the presence of strangulation (PCC = 0.627), which can be considered as an indication for the urgent surgical treatment.