African Journal of Paediatric Surgery (Jan 2010)
Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country?
Abstract
Background: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country. Patients and Methods: This is a retrospective analysis of records of children who were managed with adhesive intestinal obstruction at the University of Benin Teaching Hospital between January 2002 and December 2008. Results: Adhesive intestinal obstruction accounted for 21 (8.8%) of 238 children managed with intestinal obstruction. They were aged between 7 weeks and 16 years (mean 3 ± 6.4 years), comprising 13 males and eight females (ratio 1.6:1). Prior laparotomy for gangrenous/perforated intussusception (seven, 33.3%), perforated appendix (five, 23.8%), perforated volvulus (three, 14.3%), penetrating abdominal trauma (two, 9.5%) and perforated typhoid (two, 9.5%) were major aetiologies. Adhesive obstruction occurred between 6 weeks and 7 years after the index laparotomies. All the 21 children had initial nonoperative management without success, owing to lack of total parenteral nutrition and monitoring facilities. Outcomes of open adhesiolysis performed between 26 and 48 h in six (28.6%) children due to poor response to nonoperative management, 11-13 days in 12 (57.1%) who responded minimally and 2-5 weeks in three (14.3%) who had relapse of symptoms were encouraging. Exploration of the 21 adhesive obstructions confirmed small bowel obstruction due to solitary bands (two, 9.5%), multiple bands/adhesions (13, 61.9%) and encasement, including one bowel gangrene (six, 28.6%). Postoperatively, the only child who had recurrence during 1-6 years of follow-up did well after a repeat adhesiolysis. Conclusion: Nonoperative management was unsuccessful in this setting. Open adhesiolysis may be adopted in children to prevent avoidable morbidities and mortalities in settings with limited resources.
