Conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water- soluble contrast protocol
Background/purpose: We compare the outcomes of conservative management of adhesive small bowel obstruction (ASBO) before and after the implementation of an enteral hyperosmolar water-soluble contrast protocol. Methods: We performed a retrospective chart review of all patients with ASBO admitted into...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Journal of Pediatric Surgery Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949711623000631 |
| _version_ | 1797398385805754368 |
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| author | Anaclara Fortunato Carlos Ariel Sferco Enrique Javier Romero Manteola |
| author_facet | Anaclara Fortunato Carlos Ariel Sferco Enrique Javier Romero Manteola |
| author_sort | Anaclara Fortunato |
| collection | DOAJ |
| description | Background/purpose: We compare the outcomes of conservative management of adhesive small bowel obstruction (ASBO) before and after the implementation of an enteral hyperosmolar water-soluble contrast protocol. Methods: We performed a retrospective chart review of all patients with ASBO admitted into the Hospital de Niños de la Santísima Trinidad (Córdoba, Argentina) between June 2017 through June 2022. Patients admitted before June 2020 (group 1) received traditional conservative management (no enteral feeding, gastric decompression, and intravenous hydroelectrolytic resuscitation). Surgery was indicated at the discretion of the treating surgeon. Patients admitted after June 2020 (group 2) received water-soluble contrast 12–24 h after admission. Surgery was indicated if contrast agent was not seen in the colon in a radiographic examination 24 h after the administration, or if symptoms persisted despite the presence of contrast in the colon and in case of clinical worsening or protocol discontinuation. Group outcomes were compared. Surgical rate was the main outcome. Results: Fifty-three episodes of ASBO were included. Surgical treatment was indicated in 80 % of group 1 and in 66 % of group 2 (p = 0.28). The sensitivity and specificity of hyperosmolar water-soluble contrast to predict the success of conservative management were 100 % and 60 %, respectively. The complication rate after contrast administration was 66.66 %. Vomiting was the most common complication. Conclusions: Hyperosmolar water-soluble contrast did not significantly decrease the rate of surgical procedures. However, it is a sensitive tool predicting the success of conservative management and is not associated with the occurrence of major complications. Level of evidence: Level III Type of study: Retrospective comparative study. |
| first_indexed | 2024-03-09T01:24:54Z |
| format | Article |
| id | doaj.art-e6da202e0c014ba88667ef0e8b8a5213 |
| institution | Directory Open Access Journal |
| issn | 2949-7116 |
| language | English |
| last_indexed | 2024-03-09T01:24:54Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Open |
| spelling | doaj.art-e6da202e0c014ba88667ef0e8b8a52132023-12-10T06:19:51ZengElsevierJournal of Pediatric Surgery Open2949-71162023-12-014100066Conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water- soluble contrast protocolAnaclara Fortunato0Carlos Ariel Sferco1Enrique Javier Romero Manteola2Corresponding author.; Hospital de Niños de la Santísima Trinidad, Bajada Pucará 787, Ciudad de Córdoba, Córdoba 5000, ArgentinaHospital de Niños de la Santísima Trinidad, Bajada Pucará 787, Ciudad de Córdoba, Córdoba 5000, ArgentinaHospital de Niños de la Santísima Trinidad, Bajada Pucará 787, Ciudad de Córdoba, Córdoba 5000, ArgentinaBackground/purpose: We compare the outcomes of conservative management of adhesive small bowel obstruction (ASBO) before and after the implementation of an enteral hyperosmolar water-soluble contrast protocol. Methods: We performed a retrospective chart review of all patients with ASBO admitted into the Hospital de Niños de la Santísima Trinidad (Córdoba, Argentina) between June 2017 through June 2022. Patients admitted before June 2020 (group 1) received traditional conservative management (no enteral feeding, gastric decompression, and intravenous hydroelectrolytic resuscitation). Surgery was indicated at the discretion of the treating surgeon. Patients admitted after June 2020 (group 2) received water-soluble contrast 12–24 h after admission. Surgery was indicated if contrast agent was not seen in the colon in a radiographic examination 24 h after the administration, or if symptoms persisted despite the presence of contrast in the colon and in case of clinical worsening or protocol discontinuation. Group outcomes were compared. Surgical rate was the main outcome. Results: Fifty-three episodes of ASBO were included. Surgical treatment was indicated in 80 % of group 1 and in 66 % of group 2 (p = 0.28). The sensitivity and specificity of hyperosmolar water-soluble contrast to predict the success of conservative management were 100 % and 60 %, respectively. The complication rate after contrast administration was 66.66 %. Vomiting was the most common complication. Conclusions: Hyperosmolar water-soluble contrast did not significantly decrease the rate of surgical procedures. However, it is a sensitive tool predicting the success of conservative management and is not associated with the occurrence of major complications. Level of evidence: Level III Type of study: Retrospective comparative study.http://www.sciencedirect.com/science/article/pii/S2949711623000631Conservative treatmentIntestinal obstructionPediatricsAdhesions |
| spellingShingle | Anaclara Fortunato Carlos Ariel Sferco Enrique Javier Romero Manteola Conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water- soluble contrast protocol Journal of Pediatric Surgery Open Conservative treatment Intestinal obstruction Pediatrics Adhesions |
| title | Conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water- soluble contrast protocol |
| title_full | Conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water- soluble contrast protocol |
| title_fullStr | Conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water- soluble contrast protocol |
| title_full_unstemmed | Conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water- soluble contrast protocol |
| title_short | Conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water- soluble contrast protocol |
| title_sort | conservative management of pediatric adhesive small bowel obstruction before and after implementing an enteral hyperosmolar water soluble contrast protocol |
| topic | Conservative treatment Intestinal obstruction Pediatrics Adhesions |
| url | http://www.sciencedirect.com/science/article/pii/S2949711623000631 |
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