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Adhesive Small Bowel Obstruction
Everything in the library about adhesive small bowel obstruction — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Medical Management
1 item
Gastrografin Protocol for Adhesive Small Bowel Obstruction (SBO)
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Dr. Meera Kotagal discusses the use of gastrografin for diagnosis and potential therapeutic treatment for adhesive small bowel obstruction. Here you will find the evidence-based guideline in place at Cincinnati Children's Hospital (August 2
video · Sep 2019
Evidence & Research
2 items
Best of the Best APSA Winner
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The APSA winner at the Best of the Best in Pediatric Surgery event on April 8th, 2022 was Nathan Rubalcava with his presentation "A contrast challenge is safe in children with adhesive small bowel obstruction- a multi-institutional review".
video9:46 · Apr 2022
APSA - A contrast challenge is safe in children with adhesive small bowel obstruction- a multi-institutional review - Nathan Rubalcava
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Listen to Nathan Rubalcava gave his presentation of "A contrast challenge is safe in children with adhesive small bowel obstruction- a multi-institutional review" at the first ever Best of the Best in Pediatric Surgery event.
video8:44 · May 2022
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Best of the Best APSA Winner
Adhesive small bowel obstructions are a well-known cause of morbidity in children following abdominal surgery.
clinicalNate Rubocava1:33 ↗
Traditional treatment for adhesive small bowel obstruction has been gastric decompression, bowel rest, fluid resuscitation, and electrolyte replacement.
clinicalNate Rubocava1:50 ↗
Over the last two decades, water-soluble contrast agents in management of small bowel obstructions have become well established in adult literature given their ability to predict success of non-operative management.
clinicalNate Rubocava2:05 ↗
In the contrast challenge protocol, after gastric decompression the patient is given contrast and an abdominal X-ray is obtained 8 to 10 hours later. Contrast in the colon indicates passing the challenge.
clinicalNate Rubocava2:25 ↗
Patients without contrast in colon after repeat X-ray at 24 hours are considered to have failed the contrast challenge and are taken to surgery for exploration.
clinicalNate Rubocava2:55 ↗
Limited data exists regarding safety and use of contrast challenge in the pediatric population, yet multiple pediatric institutions have adopted contrast challenge algorithms.
epidemiologicalNate Rubocava3:15 ↗
The study performed retrospective review of all children undergoing contrast challenge across 5 children's hospitals over 8 years.
clinicalNate Rubocava3:45 ↗
Primary outcome was any complication related to contrast administration, with complication rate less than 5% considered safe for clinical practice by group consensus.
clinicalNate Rubocava4:00 ↗
Major complications were defined as aspiration, pneumonia, anaphylaxis, cardiovascular complications, and renal failure. Minor complications included urticaria, dyspnea, and worsening abdominal pain.
clinicalNate Rubocava4:20 ↗
82 children underwent contrast challenge. 57 initially passed, of which 53 had clinical improvement and were successfully discharged. 25 failed and were taken to surgery.
clinicalNate Rubocava4:40 ↗
There was significant age difference between groups, with those passing the challenge a median of 7 years older, but no differences between each age group.
clinicalNate Rubocava5:00 ↗
Over 30% of patients had neurologic and pulmonary comorbidities.
epidemiologicalNate Rubocava5:15 ↗
Contrast agents used were institution-specific with relatively similar osmolality, with dilute gastrographin being most commonly utilized.
clinicalNate Rubocava5:25 ↗
There were no major or minor complications in the study, with 0% complication rate and confidence interval of 0 to 3.6%, significantly below the pre-set acceptable rate of 5%.
clinicalNate Rubocava5:40 ↗
There were no mortalities in either group.
clinicalNate Rubocava5:55 ↗
The group that failed contrast challenge had significantly longer hospital stay by 5 days.
clinicalNate Rubocava4:40 ↗
6 patients were readmitted within 30 days for recurrent small bowel obstruction.
clinicalNate Rubocava4:55 ↗
The contrast challenge has sensitivity of 100%, specificity of 86%, negative predictive value of 100%, and positive predictive value of 93%.
clinicalNate Rubocava5:05 ↗
This review of 82 patients is the largest to date in children demonstrating that contrast challenge is safe, effective, and highly predictive.
clinicalNate Rubocava5:30 ↗
Every institution had similar protocol that had been mirrored to Dr. Grace Mack from University of Chicago's study from 2018.
clinicalNate Rubocava6:59 ↗
The Midwest Pediatric Surgery Consortium is conducting a prospective study looking at contrast challenges in pediatric adhesive small bowel obstruction.
clinicalNate Rubocava7:25 ↗
More pediatric surgeons have adopted the practice after seeing it was safe and effective in predicting which children will be successfully managed non-operatively.
opinionNate Rubocava7:55 ↗
This contrast challenge will positively impact management of every child that undergoes abdominal surgery because they are at risk of adhesive small bowel obstruction for the rest of their life.
opinion9:06 ↗
APSA - A contrast challenge is safe in children with adhesive small bowel obstruction- a multi-institutional review - Nathan Rubalcava
Adhesive small bowel obstructions are a well-known cause of morbidity in children following abdominal surgery
clinicalNate Rubocava0:33 ↗
Traditional treatment for adhesive small bowel obstruction has been gastric decompression, bowel rest, fluid resuscitation, and electrolyte replacement
clinicalNate Rubocava1:00 ↗
Over the last two decades, water-soluble contrast agents in management of small bowel obstructions have become well established in adult literature given their ability to predict success of non-operative management
clinicalNate Rubocava1:20 ↗
A contrast challenge is performed after a period of gastric decompression, with abdominal X-ray obtained 8 to 10 hours after contrast administration
clinicalNate Rubocava1:45 ↗
Contrast in the colon is considered having passed the contrast challenge, and patients are discharged after demonstrating clinical improvement with tolerance of regular diet
clinicalNate Rubocava2:10 ↗
Patients without contrast in colon after repeat abdominal X-ray at 24 hours are considered to have failed their contrast challenge and are taken to surgery for exploration
clinicalNate Rubocava2:30 ↗
Limited data exists regarding safety and use of contrast challenge in the pediatric population, despite multiple pediatric institutions adopting contrast challenge algorithms
epidemiologicalNate Rubocava2:50 ↗
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