Pediatric Small Bowel Obstruction: Can we learn from adults? Phillip A. Bilderback, MD Surgery Resident Virginia Mason Medical Center Seattle, WA

2100 patients who underwent laparotomy at a single institution 2.8% developed post-op bowel obstruction (median f/u 3.2 years) 70.5% required operative intervention 2x as common in patients younger than 1 year (28/601, 4.7%) as in older children (33/1586, 2.1%; P =.01) Not influenced by initial diagnosis and indication for laparotomy (P =.26) 2/3 children <1 yr presented w/in 1 yr, 75% w/in 2 yrs 80% older children presented w/in 1 yr

Population-based study: 1581 children <16 yo from administrative database Followed for 4 years Kids <5 yo: 4.2% had adhesion-related readmission Kids <16 yo: 1.1% has adhesion-related readmission 55% of all readmissions occurred in the first year.

CT Scan in adults

2,089 pts admitted with SBO from KID database 1,786 (85.5%) underwent operative intervention with LOA (83.6%) or bowel resection (16.4%) Factors associated with the use of operative intervention were younger age, race, and management at a children’s hospital. The time from admission until operation was significantly longer in patients who underwent bowel rsxn (2.1 days) compared with LOA (1.5 days).

Retrospective study of an administrative database 165 admissions, 32 (19%) were managed with immediate op, 133 were initially managed nonop 107 (84%) went on to laparotomy 16% were managed successfully nonop. Delayed surgery or conservative management did not cause an increase in complications

Prospective inclusion of pts w/ uncomplicated SBO Unimproved after 48 hrs conservative Rx 8 pts matched to 16 controls on number of previous SBOs mL gastrografin administered If constrast in cecum in 4-6 hrs started feeding and discharged

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