• Annals of surgery · Jan 2024

    Utility of Enteral Contrast Protocols in Pediatric Adhesive Small Bowel Obstruction: A Prospective Multicenter Observational Study.

    • Shannon N Acker, Romeo Ignacio, Katie W Russell, Lorraine Kelley-Quon, Katrine Lofberg, Justin Lee, Aaron R Jensen, Kaci Pickett-Nairne, Connor Prendergast, Stephanie E Iantorno, Hari Thangarajah, Utsav Patwardhan, Caroline Melhado, Allen Zhong, Ben Padilla, David H Rothstein, Lauren Nicassio, Samir Pandya, Maria Valencia, Kasper Wang, Tom H Inge, and Western Pediatric Surgery Research Consortium.
    • Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
    • Ann. Surg. 2024 Jan 23.

    ObjectiveOur objective was to determine the utility of enteral contrast-based protocols in the diagnosis and management of adhesive small bowel obstruction (ASBO) for children.BackgroundEnteral contrast-based protocols for adults with ASBO are associated with decreased need for surgery and shorter hospitalization. Pediatric-specific data are limited.MethodsWe conducted a prospective observational study between October 2020 and December 2022 at nine children's hospitals who are members of the Western Pediatric Surgery Research Consortium. Inclusion criteria were children aged 1-20 years diagnosed with ASBO who underwent a trial of nonoperative management (NOM) at hospital admission. Comparisons were made between those children who received an enteral contrast challenge and those who did not. The primary outcome was need for surgery.ResultsWe enrolled 136 children (71% male; median age: 12 y); 84 (62%) received an enteral contrast challenge. There was no difference in rate of operative intervention between the no contrast (34.6%) and contrast groups (36.9%; P=0.93). Eighty-seven (64%) were successfully managed nonoperatively with no difference in median length of stay (P=0.10) or rate of unplanned readmission (P=0.14). Among the 49 children who required an operation, there was no significant difference in time from admission to surgery or rate of small bowel resection based on prior contrast administration.ConclusionsThe addition of enteral contrast-based protocols for management of pediatric ASBO does not decrease the likelihood of surgery or shorten hospitalization. Larger randomized studies may be needed to further define the role of radiologic contrast in the management of ASBO in children.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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