Timing of operation for long-term adhesive intestinal obstruction after laparotomy in children

Abstract

Objective To investigate how to consider the timing of treatment for adhesive intestinal obstruction after laparotomy in children, so as to avoid long-segment bowel necrosis and resection as much as possible. Methods Clinical data of 57 children with long-term adhesive intestinal obstruction after laparotomy were retrospectively analyzed; the time from intestinal obstruction onset to the primary operation, numbers of conservative treatment and operation, the modes of primary operation and secondary operation, cause of intestinal obstruction and corresponding ratios in the 57 children were recorded and compared. Results In 57 children, the mean time from intestinal obstruction onset to primary operation was 7.6 months, and 42 cases had onset within 1 year after the primary operation. Among the 57 children, 49 children underwent enterectomy as primary operation, 6 children underwent appendectomy as primary operation and 2 children had experienced abdominal tumor surgery; 25 children were cured and discharged after conservative treatment, 32 children were treated by operation of which 13 cases underwent emergency treatment and 19 cases were reallocated to operation mode due to false conservative treatment. Among the 32 children with intestinal obstruction treated by operation, 26 cases were caused by the small intestinal adhesions, 3 cases were caused by the small intestine and incision adhesion, and 3 cases were caused by fibrous cord pressing intestine; of the 32 children who underwent operation, 6 cases received enteral tube with intestinal plication, and 17 cases were complicated by intestinal necrosis and received enterectomy and anastomasis, and 9 cases only underwent enterolysis. Conclusions Adhesive intestinal obstruction in children, after abdominal operation, progresses rapidly, and tends to lead intestinal necrosis, so operation should be performed positively. Once the child presents infection poisoning symptoms, conservative treatment performs no obvious improvement within 2 days or the abdominal plain film shows fixed intestinal obstruction, operation should be conducted positively; once peritonitis occurs, doctors should be on high alert for intestinal obstruction. Prolonged conservative treatment may increase the risk of intestinal necrosis and resection. Key words: Children; Adhesive intestinal obstruction; Timing of operation