ADHESIVE SMALL-BOWEL OBSTRUCTION IN CHILDREN - PREDICTORS OF VASCULAR COMPROMISE OF THE INTESTINE

The records of 228 episodes of adhesive small-bowel obstruction (ASBO) in 179 children were reviewed retrospectively to evaluate criteria to predict the presence of vascular compromise of the intestine and to establish safety limits for conservative treatment. Among 228 episodes of ASBO, 16 (7%) were associated with vascular compromise while 212 (93%) were without. The predictability of the proposed criteria, which included localized abdominal tenderness, tachycardia, fever, and leukocytosis was studied individually and in combination. Of the individual criteria, the presence of tachycardia and localized abdominal tenderness correlated significantly with the presence of vascular compromise (P < 0.001, P < 0.01, respectively). Mean body temperatures and white blood cell counts in vascularly compromised and noncompromised episodes also showed significant differences (P < 0.001, P < 0.01). When the criteria were evaluated in combination, in the absence of all four criteria all patients were without vascular compromise. In the presence of one, two, or three criteria, the chances of encountering vascular compromise were 3%, 18%, and 50%, respectively. Since vascular compromise was not encountered in cases without any of the four criteria, conservative treatment may safely be initiated in these selected cases. Operative treatment should be reserved for children who have one or more criteria.