The burden of adhesive bowel obstruction requiring surgery in children: a single-center retrospective review
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In brief
In brief
This retrospective study examines 71 pediatric patients requiring surgery for adhesive bowel obstruction over nine years, identifying appendicitis, NEC, and gastroschisis as leading antecedent conditions. The 41% complication rate doubled hospital stays, with bowel resection and prolonged operative time emerging as key risk factors for adverse outcomes.
- Adhesive bowel obstruction requiring surgery affects children from 11 days to 18 years, most commonly after appendicitis, NEC, or gastroschisis repair.
- 41% of pediatric ABO cases develop postoperative complications, which double the hospital length of stay.
- Longer operative time and bowel resection are associated with increased complications; prior infant surgery and recurrent ABO predict longer operations.
- Median time from initial surgery to ABO is 6.4 months, but range extends to 16 years, making long-term surveillance important.
- Post-appendicitis ABO cases have significantly shorter operative times (82 vs 175 min), suggesting less severe adhesive disease than other etiologies.
Written by the GCMD Library team from the article.
Abstract
Purpose
Investigate causes, predictors, and complications of adhesive bowel obstruction (ABO) necessitating surgery in children.
Methods
Single-center retrospective review of operative cases classified as ‚adhesive bowel obstruction ‘ between May 2014 and December 2023. Parameters assessed included previous surgeries, operative time (indicative of adhesion extent), length of stay and postoperative complications. Results were statistically analyzed afterward.
Results
We identified 71 patients with ABO; seven had recurrences. Age (11 d—18 y, median 5.9 y) and time after surgery (four days—16 years, median 6.4 months) varied considerably. Preceding appendicitis (16 cases), NEC (seven cases) and gastroschisis (five cases) were most prevalent. Operative time ranged from 43 min to 8.4 h, was longer after previous surgery during infancy (median 177 vs. 124 min), recurrent ABO (median 213 vs. 150 min) and significantly shorter after appendicitis (82 vs. 175 min). ICU stay (median 2 days) and hospital stay (median 11 days) reduced with age. 32 patients (41%) suffered complications, doubling mean lengths of stay. Bowel resection and longer surgery were associated with complications, while age and enterostomy creation were not.
Conclusion
ABO is an impactful complication with limited predictors. The high incidence of complications adds to the burden for patients, parents, and health systems.