Diagnosis and surgical management strategy for pediatric small bowel obstruction: Experience from a single medical center

Abstract

Identifying Bowel strangulation and the approach and timing of surgical intervention for pediatric SBO are still uncertain. In this study, 75 consecutive pediatric patients with surgically confirmed SBO were retrospectively reviewed. The patients were divided into group 1 (n = 48) and group 2 (n = 27) according to the presence of reversible or irreversible bowel ischemia, which was analyzed based on the degree of ischemia at the time of operation. The results demonstrated that the proportion of patients with no prior abdominopelvic surgery was higher, the serum albumin level was lower, and the proportion of patients in which ascites were detected by ultrasonography was higher in group 2 than that in group 1. The serum albumin level was negatively correlated with ultrasonographic findings of the fluid sonolucent area in group 2. There were significant differences in the choice of surgical approach between group 1 and group 2. A symptom duration of >48 h was associated with an increased bowel resection rate. The mean length of hospital stay was shorter in group 1 than that in group 2. In conclusion, immediate surgical intervention should be considered in patients with a symptom duration of >48 h or the presence of free ascites between dilated small bowel loops on ultrasonography. Laparoscopic exploration is recommended as first-line treatment in patients with stable status.

The Relationship between Neutrophil-Lymphocyte Ratio to Intestinal Viability in Invagination Patients at Dr. M. Djamil General Hospital, Padang, Indonesia

“…Early surgical intervention for pediatric patients with SBO can avoid unnecessary bowel resection as well as reduce perioperative morbidity and mortality. 7 Research by Yao et al (2015) states that loss of intestinal viability in the group of invagination cases is significantly associated with the length of the history of the disease (P = 0.000). In addition, the risk of loss of intestinal viability is higher in women (31%) than men (20.8%) (P = 0.049).…”

“…showed variations in NLR values with an increasing trend, with values of 0.92 in the control group, 1.07 in the infected group, and 1.65 in the sepsis group, indicating a link between sepsis incidence and NLR values 7. Proinflammatory and inflammatory processes can increase the risk of an uncontrolled innate immune system, cause tissue damage, and cause septic shock and organ failure due to the aggressive activation of defense mechanisms.…”