ADHESIVE SMALL-BOWEL OBSTRUCTION IN CHILDREN

Seventy-one episodes of adhesive small-bowel obstruction (ASBO) in 57 children were reviewed to define the relationship of treatment methods to clinical conditions and to examine the place of conservative treatment. Thirteen children received urgent operations on the day of admission because of signs of suspected strangulation or complete obstruction. The remaining 58 episodes underwent initial conservative treatment, which was successful in 35 while 23 required subsequent surgical intervention, an overall incidence of operation in 36 of the 71 (50.7%) episodes of ASBO. Seven episodes required bowel resection, strangulation was found in 3 (4.2%), and mortality occurred in 1 (1.7%) due to delayed operation. Patients with more than one previous successfully treated occurrence of ASBO were significantly more likely to respond to conservative treatment (71.4% vs. 54.4%, P <0.05). Those patients who had undergone laparotomies twice or more before the episode were more likely to be successfully treated by conservative treatment than those who underwent laparotomy only once before (80% vs. 52.4%, P <0.01). Whether or not the treatment of the previous occurrences of ASBO was surgical, we found that the initial treatment of any further episode could be conservative except when evidence of a complete or strangulated bowel obstruction developed.