Postoperative Small Bowel Obstruction in Infants and Children

Abstract

In the Pediatric Surgical Department of The St Radboud Hospital, Nijmegen, The Netherlands, between January 1970 and December 1980, 1476 laparotomies were performed on neonates, infants, and children. In 33 of these patient the abdominal surgery was complicated by a postoperative small bowel obstruction (SBO), for which a second laparotomy had to be performed. In 80% of patients this SBO developed within three months of the prior operation. The risk of developing an adhesive SBO was greater when there was more than one prior peritoneal procedure, and when, during this prior procedure, there was already a peritonitis. There was no obvious relation with the nature of the original operation. In more than 70% of patients a single adhesion caused the obstruction, while in many of these cases there were already circulatory disturbances, even by early reintervention. The mortality was 6%.

The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity

“…The most commonly performed second surgical intervention in CDH is reexploration for small bowel obstruction [32,110]. This percentage is considerably higher than those of postoperative intestinal obstruction in other patients who had laparotomy in the neonatal period, infancy and childhood (2.2-6%) and in patients who had Ladd's procedure for malrotation (8.3%) [111][112][113], but comparable to patients operated for gastroschisis or omphalocele [114]. Several mechanisms may contribute to the increased susceptibility to intestinal obstruction among patients with diaphragmatic defects.…”

Evaluation of a Series of Patients Operated For Adhesive Intestinal Obstructions

“…A series involving 2000 laparotomy operations adhesive operations had an incidence of 1%, half occurring in the first month [16]. It was also argued that adhesions occurring after appendectomy and herniorrhaphy operations tend to develop later than those occurring after gynaecological and colorectal operations [5,12,16]. In our study, 62.2% of surgeries for AIOs were performed in the first three months and 84.4% in the first year.…”

“…Festen advocated performing urgent surgery for AIOs based on an increased risk of peritonitis, intestinal opening during operation, and intestinal circulatory derangement even with undelayed operations [5]. A study involving 181 AIO cases revealed that cases without fever, leukocytosis, tachycardia, or abdominal tenderness could be conservatively managed and only 26.2% of patients required surgery [10].…”

“…These patients were closely observed unless they showed signs of strangulation. Furthermore, those advocating urgent surgery for AIO also note that approximately 60% of all cases could be improved without surgery [5]. Conservative management of AIOs is also widely applied in adult age groups [11].…”

“…Intestinal obstruction secondary to adhesions occur at a rate of 10-20% after conservatively managed inflammatory disorders such as acute appendicitis, acute cholecystitis, diverticulitis, pelvic inflammatory disease, and inflammatory bowel disease, and at a rate of as high as 80-90% as a late complication after laparotomy operations [2]. Although the exact incidence of adhesion-induced intestinal obstructions is unknown, several reports have provided figures ranging between 1.1% and 8.3% [3][4][5][6]. Unfortunately, this natural healing process may lead to complications including abdominal pain, inability to perform daily activities or to attend school, malaise or pain, and growth retardation, but it may also give rise to serious complications such as hospital admission or re-operation [3].…”