Changing the Paradigm for Managing Pediatric Nonadhesive Small Bowel Obstructions-Should We Operate?

Introduction: Growing evidence supports the success of nonoperative management (NOM) for pediatric adhesive small bowel obstruction (A-SBO). However, there is concern that patients with nonadhesive SBO (NA-SBO) will have repeat episodes of SBO if not treated with surgery upfront. We examined whether NOM of NA-SBO at initial presentation was associated with increased risk of recurrent SBO.

Methods: A single-center observational study was performed using Current Procedural Terminology/International Classification of Disease (ICD) codes and chart review. NA-SBO was defined as SBO in a patient with no history of SBOs, prior abdominal surgeries, or congenital gastrointestinal abnormalities known to cause SBO. We excluded patients with incarcerated hernias and tumors. The independent variable was surgical treatment at initial SBO admission and primary outcome was SBO recurrence within 1 y.

Results: Our cohort included 97 patients, with 30 patients (31%) undergoing surgery at initial NA-SBO admission. There was no difference in rates of recurrent SBO within 1 y when comparing the operative versus nonoperative management groups (6.7% versus 8.9%, P = 0.70). Among patients who recurred, there was no difference in need for surgical intervention (2/6 versus 0/2, P = 0.34). None of the operations for recurrence were urgent or emergent. Patients managed nonoperatively had a shorter median length of stay (2 versus 7 d, P < 0.001) and did not have significantly more emergency room visits (10.4% versus 6.7%, P = 0.55).

Conclusions: NOM of NA-SBO was not associated with increased rates of SBO recurrence, and NOM did not lead to increased morbidity. Surgeons should consider NOM in stable pediatric patients who present with NA-SBO.